You have the right to receive a ‘Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients an estimate that shows the costs of items and services that are reasonably expected for their health care needs.
This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here.
The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. There may be additional items or services that are recommended as part of your care that must be scheduled or requested separately and are not reflected in this Good Faith Estimate. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You 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. You may also start 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 (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
PO BOX 1162
Jacksonville AL, 36265-4306
Good Faith Estimate for Our Services
NOTE: These estimated costs are for those clients who do not have health insurance, who are choosing not to file under their health insurance plan, or whose health insurance does not cover counseling services for their individual needs.
This estimate DOES NOT reflect costs for clients who are filing under their health insurance plan benefits.
You are entitled to receive this Good Faith Estimate of what the charges could be for our counseling services provided to you. While it is not possible for us to know, in advance, how many counseling sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services.
Your total cost of services will depend upon several factors:
- the number of counseling sessions you attend
- your individual circumstances
- any insurance benefits including copays or deductibles, you may have
- and the type and amount of services provided to you
The following is a detailed list of charges for Counseling Services provided by Garrett Counseling ( NPI #: 1295000503):
90791: Assessment Session – Cost: $125.00
90832: 30 minute Session – Cost: $75.00
90834: 45 minute Session – Cost: $115.00
90837: 60-minute Session – Cost: $125.00
90846: Family Session without Client – Cost: $125.00
90847: Family Session with Client – Cost: $125.00
90853: Group Session – $35.00
90785: Play Therapy added to session – Cost: $25.00
Although the total number of sessions required to meet your goals is unknown at this time, the average number of sessions for a similar diagnosis is 52. Depending on the progress that we make, we expect that you will need 30-52 sessions.
Again, this is an ESTIMATE. This is not a bill and this does mean that you are requested/required to attend all 52 sessions.
Therefore, the estimated cost, if you attend 52, 60-min sessions, would be:
Assessment Session – 1 @$125.00
60- minute Session – 51 @$125.00
For a TOTAL ESTIMATED COST OF $6500.00
This estimate expires on December 31st, 2023