Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

Therapy Costs

We want our clients to have a good idea what therapy will likely cost. Clinicians normally determine a per-session fee with clients during an intake phone call prior to the first session; if clients are ever uncertain about what their session fee is, we are happy to remind them. Having an understanding of their per-session fee and average treatment duration allows clients to get a Good Faith Estimate of treatment costs (fee x number of sessions = cost). Based on our data, estimated average total cost ranges are the following:  

Since we have not yet evaluated your difficulties or symptoms, we must at this point estimate your course of treatment based upon the national average for a course of psychotherapy, which is 18 encounters. This will be different if specialized treatment is being provided. 

Anticipated treatment:

(Per-session fee range is $100-$250+)

1 session of CPT 90791 (diagnostic evaluation) at $175

17 weekly sessions of CPT 90834 (psychotherapy, 45 minutes) at $157 per session

Total of estimated "fee for services" treatment without insurance: $2,400

This is just a rough estimate based on national averages. The duration of our work together can be longer or shorter depending upon your symptoms, your work between sessions, and your response to treatment.

This initial estimate is valid for 12 months, but you are entitled to receive an update on this estimate at any time upon request.

Less Common Costs

Although less common, there may be additional items or services provided as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate. The fee for report writing (psychological evaluations, treatment summaries, etc.) is identical to the client's session fee with a minimum of one hour paid in advance. The fee must be paid in full before the requested document is released. Phone conversations and other consultations are billed to the nearest quarter hour and based on the client’s session fee (e.g., 10 minute phone consultation for a client who is normally charged $150 for a session would cost $37.50). Clients and/or attorneys must pay the clinician’s standard per-session fee for courtroom testimony by a clinician, with a minimum of three hours payable in advance, when honoring a subpoena and/or when providing testimony in court, regardless of whether or not the clinician actually testifies. If clients or someone representing our clients requests their clinical record, there is a $50 file location and/or printing fee.

Obtaining a Good Faith Estimate

Clients may ask their clinician for a Good Faith Estimate at any time. This Good Faith Estimate shows the costs of items and services that are reasonably expected for client health care needs for an item or service. The Good Faith Estimate document includes, but is not limited to, the following information:

• Client name
• Client date of birth
• Description of the services that will be provided, in understandable language. At Blooming Minds Counseling, these services are individual, couple, or family therapy. The CPT codes most often associated with these services are:
  
• 90832: Psychotherapy 30 minutes with patient
• 90834: Psychotherapy 45 minutes with patient
• 90837: Psychotherapy 60 minutes with patient
• 90846: Family psychotherapy 50 minutes without the patient present
• 90847: Family psychotherapy 50 minutes conjoint psychotherapy with the patient present
• 90849: Multiple-family group psychotherapy
• 90853: Group psychotherapy (other than of a multiple-family group)
• Itemized list of goods or services reasonably expected to be provided in connection with the scheduled services. In our practice, this would be the number of individual, couple, and family therapy sessions and the date/s on which they occurred as well as a description of the average client experience (i.e., number of sessions, fee range).
• Diagnostic codes, service codes, and expected charges associated with each of those goods or services. Before the first session or prior to the completion of a biopsychosocial assessment (i.e., usually within the first three sessions), it is impossible to provide clients with a specific disorder/dysfunction diagnosis (e.g., Major Depressive Disorder, Generalized Anxiety Disorder, etc.) on their documented good faith estimate. “Other Counseling or Consultation (V65.40)” is the diagnosis we use when clients do not meet the criteria for another diagnosis in the DSM, when clients have yet to complete their biopsychosocial assessment with their clinician, or when the primary topics discussed in treatment are not related to a specific disorder/dysfunction diagnosis met by a client.
• Provider name, NPI, and tax ID number
• Office location where services will be provided. This may include in-person or telehealth sessions.

Disclaimer

The Good Faith Estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not obligate or require the client to obtain any of the listed services from the provider and does not include any unknown or unexpected costs that may arise during treatment. Clients could be charged more if complications or special circumstances occur. If this happens, federal law allows clients to dispute (appeal) the bill.

Right to Dispute

If clients are billed for more than their Good Faith Estimate, they have the right to dispute the bill. Clients may contact the clinician or facility listed on this document to let them know the billed charges are higher than the Good Faith Estimate. Clients can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. Clients may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).

If clients choose to use the dispute resolution process, they must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee (at last check) to use the dispute process. If the agency reviewing a client dispute agrees with the client, the client will have to pay the price on this Good Faith Estimate. If the agency disagrees with the client and agrees with the health care provider or facility, the client will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call (800) 368-1019.

For questions or more information about client rights to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.

Clients should keep a copy of their Good Faith Estimate in a safe place or take pictures of it. Clients may need it if they are billed a higher amount.

Our clinic accepts most major insurance plans, including most plans by:

• Cigna
• Aetna
• Ambetter (of Tennessee)
• Magellan Healthcare
• BlueCross BlueShield
• Evernorth Health Services
• Optum
• UnitedHealthcare
• Wellpoint

We are also in network with most Medicaid plans.

Blooming Minds Counseling cannot bill to and we are not in network with any Medicare plans at this time, even if they are associated with a company we are in network with, or if you have secondary insurance with a company we are in network with.

EAPs: Our supervised clinicians cannot accept any EAPs, and being in -network with an insurance company listed above does not guarantee EAP coverage with any of our providers. We work with very limited EAP plans.

Always check with your insurance to be sure that we are in network.

The benefit to using insurance for therapy appointments is that your insurance offers you a discounted rate from our full private pay fee for therapy services.

Your insurance benefits will determine how much you will owe for your therapy sessions, based on the rates the insurance has set and your specific benefits.

Some insurances will cover therapy services 100% (Medical Assistance for example), and other plans will come with a co-pay, deductible, and/or co-insurance that clients will owe for therapy services.

Our clinic accepts private pay clients in addition to clients with the insurances listed above.  Our private pay rates and all associated rates are listed  here. 

Our policies state that clients who are not covered under insurance are fully responsible for all therapy costs at the time of service. Clients who do not have insurance, are out of network, or are choosing not to use their benefits, may additionally be asked to sign a waiver related to their specific situation, as required by federal guidelines or insurance contracts if opting out of insurance benefits.

Many clients have multiple active insurance policies at one time and multiple policies are then responsible for your therapy coverage. Please note that clients cannot pick and choose which insurance policy they would prefer to use at any given time. Insurance companies determine which insurance is primary, secondary, and so on. We are required to follow the policy order for claim submission and therefore must be aware of all policies that are active for our clients. We appreciate your understanding!

If insurance coverage ends at any time, clients will become financially responsible for therapy services engaged after coverage ends.

Clients are responsible for providing up-to-date insurance information 1 week prior to all therapy appointments in order to use insurance benefits.

If insurance changes and that new information is not provided prior to the appointment, clients will be fully financially responsible for therapy services that occurred prior to notification.

Clients are additionally fully financially responsible for any missed appointments and late canceled appointments.

This is outlined in our Policies.