As required under the No Surprises Act: 

 

This notice is provided in accordance with the federal No Surprises Act to help you understand and anticipate the costs of your healthcare prior to receiving services.

 

The law requires healthcare providers to offer a Good Faith Estimate (GFE) for out-of-network or uninsured patients, outlining expected charges for scheduled or requested services.

 

My Services Include:

• Psychiatric medication management

• Individual psychotherapy

• Combination treatment (therapy and medication)

 

Current Fees (Subject to Change):

• Initial 90-minute intake: $825

• 50-minute follow-up: $450

• 25-minute follow-up: $300

 

A sliding scale is available for individuals with financial hardship or income below certain thresholds. Please inquire directly if you would like to be considered.

 

Please note that the number of sessions required, and the total cost of care, can vary depending on your individual needs, goals for treatment, and agreed-upon frequency of visits. This Good Faith Estimate does not represent a contract or commitment to receive services, nor does it guarantee a specific treatment outcome or duration.

 

Insurance Reimbursement:

I am out-of-network and do not bill insurance directly. I will provide a superbill which you may submit to your insurer. Please confirm with your insurer if out-of-network services are covered.

 

Your Rights:

If the actual charges for services rendered exceed this Good Faith Estimate by $400 or more, you have the right to dispute the bill. In such cases:

• Contact me directly to discuss the discrepancy, review charges, and explore possible resolution.

• You may also initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS).

 

To begin a formal dispute through HHS:

• You must start the process within 120 calendar days of receiving the original bill.

• There is a $25 fee from HHS to initiate this process.

• If the reviewing agency agrees with your estimate, you will only be required to pay the Good Faith Estimate amount. If they do not, you will be responsible for the higher bill. For more information or to initiate a dispute, visit www.cms.gov/nosurprises or call HHS at (800) 368-1019.