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Good Faith Estimate

Starting January 1, 2022, the "No Surprises Act" was implemented, mandating that mental health professionals must issue a "Good Faith Estimate" (GFE) detailing the expected costs of out-of-network services. This requirement applies to patients who either lack insurance or choose not to use their insurance for covering the cost of health care items or services.


The purpose of the Good Faith Estimate is to provide a clear indication of the expected expenses for your mental health care, based on the information available at the time of estimate preparation. It's important to note that the estimate does not cover unforeseen or additional costs that may emerge during treatment.


Patients are guaranteed a Good Faith Estimate for the psychotherapy services they will receive. Although the exact number of sessions required cannot be predetermined at the start of psychotherapy, the estimate offers an insight into the potential costs involved. The final cost will depend on several factors, including the number of sessions attended, your specific circumstances, and the type and volume of services rendered. It is crucial to understand that this estimate does not bind you to receive any services from First Circle Therapy, LLC, nor does it cover any services not specifically mentioned.


Good Faith Estimate Overview:

This estimate is not meant to suggest a particular treatment plan or the exact number of psychotherapy sessions you might need. The suitable number of sessions, along with the estimated costs, will be determined based on your individual requirements and the agreements made with your therapist. You have the right to question any treatment suggestions and can terminate therapy at any time.


An initial assessment is charged at a one-time fee of $160 (CPT Code 90791). Following this, each standard 50-minute psychotherapy session, conducted via telehealth, is also charged at $160 (CPT Code 90837). While the typical frequency is one session per week, your personal needs and preferences might lead to a different schedule. When estimating your total expenses, consider possible breaks for vacations, holidays, and illness.


On average, a client may undergo up to 46 therapy sessions annually, resulting in an approximate out-of-pocket cost of $7,360 per year. However, the actual duration and frequency of therapy sessions needed can vary greatly among clients, influenced by factors such as personal schedules, therapist availability, ongoing challenges, and financial considerations.


The frequency and duration of therapy will be continually assessed by you and your therapist, who will decide together on the achievement of your therapy goals or the need for a revised Good Faith Estimate if your session frequency or requirements change. You can request an updated GFE at any time during treatment by submitting a written request.


Good Faith Estimate Disclaimer:

This estimate outlines the expected costs for your health care needs based on the information available at the time of its creation. It may not include all possible services your provider might recommend. Remember, this is only an estimate, and the actual charges may vary. The estimate does not cover unexpected costs not anticipated in the course of treatment. Additional charges might apply in the case of complications or unique circumstances, and other possible costs could include fees for late cancellations/ missed appointments, record requests, letter writings, care coordination, and other services as detailed in the Informed Consent documentation. A new Good Faith Estimate will be provided if these services are needed. This estimate does not compel you to procure any listed services.


If the final charges significantly exceed the Good Faith Estimate by $400 or more, you are entitled to initiate a dispute resolution process. You are encouraged to discuss any questions or concerns regarding your treatment plan, or this estimate with your provider at any time.

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