Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act” which requires practitioners to provider a “Good Faith Estimate” of the costs you may incur as a result of utilizing out-of-network medical care. The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for therapy. 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. You could be charged more if complications or special circumstances occur and will be provided a new “Good Faith Estimate” should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your therapist have not previously talked about the change and you have not been given an updated good faith estimate.

Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care items and services to receive a “Good Faith Estimate” of expected charges. Timeline requirements: Practitioners are required to provide a good faith estimate of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service. That estimate must be provided within specified timeframes: If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling; If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.

Common Services at Flourish Counseling and Wellness, PLLC, with our “full fee” per session:

90791: Initial therapy intake session = $200

90837: Ongoing therapy appointments (53-60 minutes) = $200

90834: Ongoing therapy appointments (37-53 minutes) = $140

90832: Ongoing therapy appointments (16-36 minutes) = $125

90847: Family appointments (approx 30-55 minutes) = $200

90846: Family appointments without client present: (approx 30 minutes) = $125

Please note that we do not provide couples / marriage counseling as a “medically necessary” service for mental health treatment and couples / marriage counseling is therefore not covered by the No Surprised Act, unless one party meets medical necessity for a mental health diagnosis that is actively being treated as part of their services. The fee for initial and ongoing couples / marriage counseling sessions is \$250.

Additional separate charges will occur in the event that your therapist is involved in services that are not directly providing mental health treatment as outlined above, such as involvement in court proceedings or letter writing on your behalf. These additional non-medical fees are outlined in our consent for services.

Some of the common diagnosis codes treated at Flourish Counseling and Wellness, PLLC are:

F43.20 – Adjustment Disorder, Unspecified

F90.2 – Attention-deficit/hyperactivity disorder, Combined presentation

F84.0 – Autism spectrum disorder

F31.81 – Bipolar II disorder

F41.1 – Generalized anxiety disorder

F33.9 – Major depressive disorder, Recurrent episode, Unspecified

F41.0 – Panic disorder

F43.10 – Posttraumatic stress disorder

F94.0 – Selective mutism

F93.0 – Separation anxiety disorder

F40.10 – Social anxiety disorder

F40.248 – Specific phobia, Other

F43.89- Unspecified trauma- and stressor-related disorder

Please know that this list is not exhaustive and that your diagnosis may not be shown on the list above and may change over time based on many factors. Please speak to your therapist with any questions or concerns you have related to your diagnosis and we can provide you with additional information and/or documentation upon request.