Good Faith Estimate
In accordance with the federal No Surprises Act, which took effect on January 1, 2022, behavioral health care providers are obligated by law to provide uninsured and self-pay clients with a good faith estimate of costs for services either when scheduling care or upon client request. This requirement ensures that clients can receive estimated costs in advance, helping them avoid unexpected bills. Please note that the actual charges may vary, as the good faith estimate is not a service offer or contract. The final cost of services may differ depending on changes, special circumstances, or other fee agreements.
The current rates for individual counseling and psychotherapy services are listed below and outlined in the Informed Consent to Psychotherapy form completed before starting therapy.
Standard 50-min Session (90834) - $200
Extended 75-min Session (90837) - $250
Other commons services provided are listed below. Note that this list is not exhaustive:
Biopsychosocial assessment (90791) - $200
Family therapy (90846-90847) - $250
Third Party Services - prorated at $200/hr
Cancellation/No-Shows - client are responsible for the full session fee for missed appointments
As a client, you have the right to determine your treatment goals and the duration of therapy unless mandatory treatment is required. Throughout the therapeutic process, you and I will regularly assess your progress, determine the appropriate session frequency, and decide when your goals have been met, signaling the end of therapy. The outlined fees are provided to facilitate discussions regarding potential costs if you choose to receive care at Deeper Routes, LLC. However, the total cost of services can be influenced by various factors, including changes in mutual availability, unforeseen life circumstances, and the specific nature of your symptoms, goals, or diagnosis.
It's important to note that Deeper Routes LLC is currently not in-network with any insurance plans. This means that there is no agreement between Deeper Routes LLC and insurance plans. Clients who have insurance coverage and choose to receive services here acknowledge that they will be responsible for the full billed cost of any items or services received. They understand that receiving services at Deeper Routes LLC may result in additional expenses. Clients are encouraged to contact their health plan for assistance in finding an in-network provider or to inquire about reimbursement for out-of-network services or application of payments toward their out-of-pocket limit. In situations where there are no in-network providers available, insurers may consider negotiating an arrangement with an out-of-network provider. However, if you did not have a choice regarding where to receive care, it is not advisable to consent to services at Deeper Routes LLC. By consenting to services at Deeper Routes LLC, you understand that you are waiving your legal protections and may be responsible for the full cost of items and services received. Your health insurance plan may not count your payments toward your deductible or out-of-pocket limit, and reimbursement may be partial or nonexistent for out-of-pocket payments. It is recommended that you contact your health plan for further information.
DISCLAIMER
This Good Faith Estimate presents the costs of items and services reasonably expected for your health care needs. The estimate is based on the information available at the time of its creation and does not include any unforeseen costs or services that may arise during treatment. In the event of complications or special circumstances, you may be charged more. Should this occur, federal law allows you to dispute (appeal) the bill.
If you receive a bill that exceeds this Good Faith Estimate, you have the right to dispute it.
You can contact the healthcare provider or facility listed to inform them that the billed charges are higher than the Good Faith Estimate. You may request an update to the bill to match the estimate, negotiate the bill, or inquire about available financial assistance. Additionally, you can initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS). The dispute process must be initiated within 120 calendar days (approximately 4 months) from the original billing date and incurs a $25 fee. If the agency reviewing your dispute agrees with you, you will only have to pay the amount indicated in the Good Faith Estimate. However, if the agency agrees with the healthcare provider or facility, you will be required to pay the higher amount.
For more information and to obtain the necessary form to begin the dispute process, please visit www.cms.gov/nosurprises or contact HHS at (800) 368-1019. If you have any questions or need further information about your right to a Good Faith Estimate or the dispute process, please visit www.cms.gov/nosurprises or call (800) 368-1019.
Deeper Routes LLC
EIN 87-4819598
OMB Control Number: 0938-1401