Good Faith Estimates and the “No Surprises Act”
The “No Surprises Act” was implemented to protect patients from unexpected medical costs resulting from receiving out-of-network emergency medical care. As of January 1, 2022, mental health providers are included in the list of providers required to provide “Good Faith Estimates” (GFE) to all current, new and prospective self-pay clients.
Self pay clients are those individuals who: 1) do not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal healthcare program, or a health benefits plan; or (2) choose not to use his or her coverage benefit for the item or service.
While each child and family is unique, please see below for a fee/service schedule as well as a sample of what to expect in terms of cost/month. This is an estimate and used for general planning purposes only. You will never be scheduled for a service you do not fully understand.
Fees/Service and General Estimates
Services and Billing Codes
90791- Diagnostic Interview, 60-90 min ($150)
90832- Individual Psychotherapy, 30 min ($80)
90834- Individual Psychotherapy, 45 min ($110)
90837- Individual Psychotherapy, 60 min ($140)
90846 - Family without child, 50 min ($110)
90847 - Family with the child, 50 min ($150)
90853 - Group, 50 min ($55 per group member)
Court Fee - $200/hour
Intake process and fees
Diagnostic Interview: All new clients must schedule a 60-90 minute caregiver-only diagnostic interview/intake session. All new clients should expect a $150 charge for this interview.
Caregiver-Child Observation Assessment: Because child therapy must address the child/care-giver relationship, an initial observation and assessment of that relationship is often needed. This service will be discussed at your intake session. If scheduled, the service will be billed as a Family Session with Child (90847) at $150.
Intake - Caregiver Only - $150
Intake + Caregiver/Child Observation - $300
Follow Up Sessions and Parent Sessions
Most children will have a weekly, individual 45 minute session. Younger children, and children with emerging attention spans may have a weekly 30 minute session. Some children benefit from a longer, 60 minute session. Every 4th session, or approximately once per month, a caregiver-only session will be scheduled to review the treatment plan and work on parenting support skills. Those caregiver sessions will be 50 minutes in length and billed at the Family without the Child session (90846) rate of $110.
Please see below for a sample monthly session fee schedule totals for children being seen at the 30 minute, 45 minute and 60 minute weekly individual session rates with the 4th week including the caregiver session in lieu of the child session. A detailed table will also be furnished upon request. Please note that this estimation assumes a child attends session 52 weeks of the year which is simply not possible, but help illustrate the costs/month.
Estimating Monthly Total
30 minute/week = $350/month
45 minutes/week = $440/month
60 minute/week = $530/month
Estimating Costs for a Year
Months 1-6 (includes intake range)
30 minutes/week = $2250-$2400
45 minutes/week = $2790-$2940
60 minute/week = $3330-$3480
Months 6-12
30 minutes/week = $2100
45 minutes/week = $2640
60 minutes/week = $3180
12 Month Totals
30 minutes/week = $4350-$4500
45 minutes/week = $5430-5580
60 minutes/week = $6510-$6660
Disputes
Federal law provides you a right to dispute your bill.
If you are billed for $400 or more than your Good Faith Estimate, you have the right to dispute the bill. You may contact Heart In Heart Child Therapy directly if you are billed charges that exceed the Good Faith Estimate.
You can request an updated bill to match the Good Faith Estimate, request to negotiate the bill, or you may request information about financial assistance availability. You also have the right to initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days from the date on the original bill. There is a $25 fee to use the dispute process. If the dispute-reviewing agency agrees with you, you will be responsible for the amount provided on your Good Faith Estimate. If the agency disagrees with your dispute and agrees with the fees charged by me that exceed the Good Faith Estimate, you will have to pay the higher amount charged.
To learn more visit www.cms.gov/nosurprises or call HHS at (800) 368-1019. Your estimate is not a contract. You are not obligated to receive services from Heart In Heart Child Therapy. Heart In Heart Child Therapy can provide you with alternative referrals at your request at any time.