no surprises act

Good Faith Estimate

Under the No Surprises Act

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 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 60-minute process group session is $75. The eight week ketamine integration group is $800 for all eight 60-minute sessions, $100 each, paid in full before the first session. A reduced fee is available in limited circumstances based on demonstrated financial need and current caseload availability, and can be discussed during the free initial consultation. The eight week ketamine integration group is the exception: it is a fixed-price cohort with no reduced fee or payment plan.

This estimate covers scheduled sessions. It does not include charges for late cancellations or missed appointments. A session cancelled less than 48 hours before its scheduled start time is charged at the full session rate, as is a missed session. A card is kept on file and charged after each session.

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.

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