Wiseman Counseling & Therapy
Jill Wiseman, MA, LPC-S

Counseling & Therapy Self-Pay Rates.

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.

 

Note: The PHSA and GFE does not currently apply to any clients who are using insurance benefits, including "out of network benefits” (i.e., submitting superbills to insurance for reimbursement). 

 

Brief explanation of estimate for new clients:

The estimate below is the estimated range of cost that is likely for most new patients.  Until your provider completes an initial diagnostic evaluation and you start to work together, your provider will not have a clear picture of your specific diagnosis, issues and needs. On average, your provider typically sees individual adult clients for an Initial Diagnostic Evaluation / Intake session followed by 8 to 16 weekly sessions for a total cost approximating $1355 to $2900, depending on the length of each session (usually between 45- and 60-minutes.) Depending on how treatment progresses, more or fewer sessions may be needed and the frequency of sessions may change. In some cases a client’s needs and goals may be more complicated, so we may need additional sessions during the time covered by this estimate. 

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Contact: If you have questions about this estimate, please contact your Provider.

 

Services Provided and Details of the Estimate:

Services provided by Wiseman Counseling & Therapy include individual therapy, couples therapy and family therapy. Below is a list of the most common services with the CPT code, service description, approximate session length, and self-pay cost of session:

• 90791 Psychiatric Diagnostic Evaluation (Intake required for all new clients) $200.00

• 90832 Individual Psychotherapy 30-minute session (range 16-37 min), $90.00

• 90834 Individual Psychotherapy 45-minute session (range 38-52 minutes) $165.00

• 90837 Individual Psychotherapy 60-minute session (range 53-89 minutes) $180.00 

• 90846 Family Therapy without the client present (range 25-74 minutes) $180.00

• 90847 Family / Couple Therapy with the client (range 25-74 minutes) $200.00

 

* Note: Estimates do not include fees such as no-show, late cancellation, letter writing, etc. Please refer to the Informed Consent for Services for these details.

 

Diagnostic Information:

Diagnosis often evolves over the course of treatment following assessment and evaluation. Your beginning Good Faith Estimate diagnostic code is: Z71.9 - Other Counseling or Consultation.

This diagnosis is only to satisfy the federal requirement for this form; this is not a formal psychological diagnosis. A formal diagnosis occurs after an assessment has been completed, which can take approximately 1 to 5 sessions after beginning psychotherapy. It is within your rights to decline a diagnosis per state and federal guidelines. At Wiseman Counseling & Therapy, we do not typically diagnose clients unless we believe a specific diagnosis to be accurate after evaluation and, after consultation with the client, if we believe that having a mental health diagnosis is in the client’s best interest and necessary for the treatment of the client.

 

Common Diagnostic Codes used at Wiseman Counseling & Therapy:

(F41.1) Generalized Anxiety Disorder ● (F43.2) Adjustment Disorder Unspecified ● (F99) Mental Health Disorder, NOS ● (F32.9) Depression Unspecified ● (F41.9) Unspecified Anxiety Disorder ● (F40.10) Social Anxiety ● (F90.2) Attention-deficit hyperactivity disorder, combined presentation  ● (Z63.0) Relationship distress with spouse or intimate partner ● (Z60.00) Phase of Life Problem ● Z63.5 Disruption of family by separation or divorce

 

Where services are rendered:  Online via Telehealth 

 

Length of Treatment:

The length of treatment varies from one client to another, as the treatment (type and duration) should always be matched appropriately to the client’s needs and goals. Acute, situational difficulties usually require fewer treatment sessions than chronic challenges.  How often and how long you attend sessions will be influenced by many factors including:

• The type of treatment provided

• Your schedule and circumstances 

• Therapist’s availability 

• Your goals, the nature of your specific challenges, and how you address them

• Your motivation and willingness to implement changes and new strategies 

• Meeting via telehealth or in-person

 

The frequency of sessions may change over the course of treatment. You and your Provider will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and feel ready to discontinue therapy. 

 

Disclaimer: This information provided is intended only to be a general informal summary of technical legal standards. It is not intended to take the place of the statutes, regulations, or formal policy guidance upon which it is based. Readers should refer to the applicable statutes, regulations, and other interpretive materials or complete and current information. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

 

The Good Faith Estimate shows the cost of items and services that are reasonably expected for your health care needs. 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. If this happens, federal law allows you to dispute the bill.

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The Good Faith Estimate is not a contract and therefore does not obligate you to accept the services listed above.

Respecting the client’s right to autonomy and self-determination is essential to a good therapeutic relationship between the client and therapist. Therefore, you (as the client) have the right to terminate services at any time.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.  You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them 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 1-800-985-3059.

 

Acknowledgement: I understand that my provider is providing a "good faith estimate” of the cost associated with my care.

I understand that if I have health insurance, and the services I am receiving from this Provider are a covered benefit under my health insurance plan, that I could choose to receive services at an "in network" provider/facility at a reduced rate.