General Information
Good Faith Estimate
Brief Explanation of Estimate for New Individual Client:
The estimate below is the cost that is likely for most new individual clients. Until I do an initial evaluation and we start to work together, I will not have a clear picture of your specific diagnosis, issues, and needs. I typically see individual therapy clients for 50 minute sessions, 16 - 24 sessions for a total cost of $2400 - $3600. But in some cases, a client’s needs may be more complicated or they may request more therapy sessions, so we may need additional sessions beyond the time covered by this estimate.
Brief Explanation of Estimate for New Couples/Family Clients:
The estimate below is the cost that is likely for most new couples/family clients. Until I do an initial evaluation and we start to work together, I will not have a clear picture of your specific diagnosis, issues, and needs. I typically see couples/family therapy clients for 50 minute sessions, 16 - 24 sessions for a total cost of $3040 - $4560. But in some cases, clients’ needs may be more complicated or they may request more therapy sessions, so we may need additional sessions beyond the time covered by this estimate.
Brief Explanation of Estimate for New Polyamorous Couples:
The estimate below is the cost that is likely for most new couples/family clients. Until I do an initial evaluation and we start to work together, I will not have a clear picture of your specific diagnosis, issues, and needs. I typically see couples/family therapy clients for 80 minute sessions, 16 - 24 sessions for a total cost of $5280 - $7920. But in some cases, clients’ needs may be more complicated or they may request more therapy sessions, so we may need additional sessions beyond the time covered by this estimate.
Services are anticipated to be provided generally on a weekly or biweekly basis until treatment is terminated. Additional services may be recommended. This estimate of your costs is only an estimate, and your actual charges may differ. You have the right to initiate the patient provider dispute resolution process if the charges you are actual billed substantially exceed the expected charges in this Good Faith Estimate, you may contact me directly or you can start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) directly. If you choose to use the dispute resolution process, that will not adversely affect the quality of health care services I provide to you. This estimate of costs is not a contract and does not obligate you to obtain clinical services from me.
Disclaimer:
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your mental health care needs. The estimate is based on the information known to me when I did the estimate. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for $400 more than this Good Faith Estimate (GFE), you have the right to dispute the bill. You may contact the Haily Haight at the contact listed above to let them know the billed charges are at least $400 higher than the GFE. You can ask them to update the bill to match the GFE, 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 GFE. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to:
www.cms.gov/nosurprises or call CMS at 1 -800 -985 -3059.
This GFE is not a contract. It does not obligate you to accept the services listed above.