Good Faith Estimate
Your right to a Good Faith Estimate
Under the No Surprises Act, effective January 1, 2022, you have the right to receive a Good Faith Estimate of the expected costs of your mental health care before beginning treatment. This right applies to all uninsured clients and to clients who choose not to use their insurance benefits. Alchemy Psychotherapy is a private-pay, out-of-network practice. All clients are self-pay clients and are entitled to a Good Faith Estimate before treatment begins.
What a Good Faith Estimate includes
A Good Faith Estimate provides an itemized list of the services expected to be provided and the estimated cost of each over a 12-month period. It is an estimate, not a contract or guarantee of cost. Your actual costs may vary depending on session frequency and duration, which are determined collaboratively based on your clinical needs and goals.
In short, a Good Faith Estimate tells you what to expect to pay for care before you commit to beginning treatment.
Current fee schedule
The fee schedule at Alchemy Psychotherapy is as follows. The biopsychosocial assessment (intake session, 60 to 90 minutes) is $300. Standard 45-minute therapy sessions are $250. A 30-minute session is $185 when clinically indicated. A reduced fee is available in limited circumstances based on demonstrated financial need and current caseload availability. This can be discussed during the free initial consultation.
How to request a Good Faith Estimate
You may request a Good Faith Estimate at any time before or during treatment. Contact the practice by phone or email to request one. You will receive your estimate within 3 business days if scheduling at least 3 business days in advance, or within 1 business day if scheduling at least 1 business day in advance.
Your right to dispute a bill
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. For information about the dispute process, visit cms.gov/nosurprises or call 1-800-985-3059.
Contact
Shayan Salar, LCSW, LCADC Alchemy Psychotherapy 4424 Gaines Ranch Loop, Austin, TX 78735 (720) 663-0103 ssalar@alchemypsychotherapy.com