Sample Good Faith Estimate Notice

 

Notice to clients and prospective clients:

Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.  

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. 

 For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises. 

  INSURANCE ACCEPTED

   REGENCE

   PROVIDENCE

   UNITED BEHAVIORAL HEALTH

     AETNA

OUT OF NETWORK: CHECK WITH YOUR INSURANCE FOR MENTAL HEALTH COSTS ASSOCIATED WITH YOUR BENEFITS PLAN

SUPERBILL AVAILABLE​

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OUT OF POCKET PAYERS

*For Video or Phone Sessions

         <INDIVIDUAL ADULT $90 THERAPY SESSION 

           <COUPLE  $100  THERAPY SESSION 

*For Live Chat Sessions

 <INDIVIDUAL ADULT $75 THERAPY SESSION 

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         ALL THERAPY SESSIONS ARE 45-50 MIN        

  SUPERVISION 

   REGISTERED ASSOCIATES  $90

   GRADUATE STUDENTS  $75