Good Faith Estimate

 

You have the right to receive a “Good Faith Estimate” explaining how much your behavioral healthcare will cost.  Under the law, healthcare providers need to give patients an estimate of the bill for services.  You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services.  If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.  For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call us at 1-888-342-8764.

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Click HERE for a copy of Fresh Start Counseling's Fee Schedule

 

The average length of stay for patients of Fresh Start Counseling is one year, and most patients attend psychotherapy once a week.  Therefore, we anticipate your treatment will require weekly 53-minute psychotherapy sessions throughout the next 12 months at $263.00 per session.  Depending on vacations, holidays, emergencies and sick time, you may attend between 44 to 52 sessions over the course of a year. At $263.00 per session, your estimated total costs are between $11,572.00 and $13,676.00 per year of receiving services at Fresh Start Counseling.  This is our Good Faith Estimate, which we are providing to you in compliance with the No Surprises Act.  You should print a copy of this Good Faith Estimate page, and keep it in a safe place (or take pictures of it). You may also ask us to provide you with a printed copy.  You may need this Good Faith Estimate if you are billed a higher amount.

Your actual costs are likely to be significantly lower than the estimate described above.  This is because insurance companies are often able to negotiate a lower "in-network" rate on your behalf.  Additionally, insurance may pay a significant portion of your behavioral healthcare fees, with the patient being responsible for their deductible and/or copays/coinsurance.  Finally, if you are uninsured, we may offer you rates on a sliding scale that is based on your income.

 

DISCLAIMER
This Good Faith Estimate shows the costs of services that are reasonably expected for your behavioral healthcare at Fresh Start Counseling. 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 more than this Good Faith Estimate, you have the right to dispute the bill. You may contact us to let us know the billed charges are higher than the Good Faith Estimate. You can ask us 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.  To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.  For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call us at 1-888-342-8764.