Good Faith Estimate

NO SURPRISES ACT: GOOD FAITH ESTIMATE

Under Section 2799B-6 of the Public Health Service Act, out-of-network healthcare providers and healthcare facilities are required to inform individuals upon request or at the time of scheduling healthcare items and services for out-of-network services, a “Good Faith Estimate” of expected charges for the year.

You have the right to receive a “Good Faith Estimate” explaining how much your care could cost over the year.

Under the law, healthcare providers need to give patients who don’t have insurance or who are using out-of-network benefits an estimate of the bill for services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests or office visits.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Based on a fee of $250 per visit, the following are expected charges of psychotherapy services:

    Total estimated charges for 1 session per week

    1 Week of Service $250

    13 Weeks of Service (Approx. 3 Months) $3250

    26 Weeks of Service (Approx. 6 months) $6500

    39 Weeks of Service (Approx. 9 months) $9750

    52 Weeks of Service (Approx. 12 Months) $13000

    Total estimated charges for 2 sessions per week

    1 Week of Service $500

    13 Weeks of Service (Approx. 3 Months) $6500

    26 Weeks of Service (Approx. 6 months) $13000

    39 Weeks of Service (Approx. 9 months) $19500

    52 Weeks of Service (Approx. 12 Months) $26000

    Total estimated charges for 1 session every other week

    1 Week of Service $250

    13 Weeks of Service (Approx. 3 Months) $1500

    26 Weeks of Service (Approx. 6 months) $3000

    39 Weeks of Service (Approx. 9 months) $4500

    52 Weeks of Service (Approx. 12 Months) $6000

  • Based on a fee of $225 per visit, the following are expected charges of psychotherapy services:

    Total estimated charges for 1 session per week

    1 Week of Service $225

    13 Weeks of Service (Approx. 3 Months) $2925

    26 Weeks of Service (Approx. 6 months) $5850

    39 Weeks of Service (Approx. 9 months) $8775

    52 Weeks of Service (Approx. 12 Months) $11700

    Total estimated charges for 2 sessions per week

    1 Week of Service $450

    13 Weeks of Service (Approx. 3 Months) $5850

    26 Weeks of Service (Approx. 6 months) $11700

    39 Weeks of Service (Approx. 9 months) $17550

    52 Weeks of Service (Approx. 12 Months) $23400

    Total estimated charges for 1 session every other week

    1 Week of Service $225

    13 Weeks of Service (Approx. 3 Months) $1350

    26 Weeks of Service (Approx. 6 months) $2925

    39 Weeks of Service (Approx. 9 months) $4500

    52 Weeks of Service (Approx. 12 Months) $5850

  • Based on a fee of $325 per visit, the following are expected charges of psychotherapy services:

    Total estimated charges for 1 session per week

    1 Week of Service $325

    13 Weeks of Service (Approx. 3 Months) $4225

    26 Weeks of Service (Approx. 6 months) $8450

    39 Weeks of Service (Approx. 9 months) $12675

    52 Weeks of Service (Approx. 12 Months) $16900

    Total estimated charges for 2 sessions per week

    1 Week of Service $650

    13 Weeks of Service (Approx. 3 Months) $8450

    26 Weeks of Service (Approx. 6 months) $16900

    39 Weeks of Service (Approx. 9 months) $25350

    52 Weeks of Service (Approx. 12 Months) $33800

    Total estimated charges for 1 session every other week

    1 Week of Service $325

    13 Weeks of Service (Approx. 3 Months) $2275

    26 Weeks of Service (Approx. 6 months) $4225

    39 Weeks of Service (Approx. 9 months) $6500

    52 Weeks of Service (Approx. 12 Months) $8450