Good Faith Estimate

Beginning January 1, 2022, federal laws regulating client care have been updated to include the “No Surprises” Act. This Act requires health care practitioners to provide current and potential clients a “Good Faith Estimate” (GFE) on the cost of treatment.

This new regulation is designed to provide transparency to patients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills. It allows patients to understand how much their health care will cost before they receive services.

There are a number of factors that make It challenging to provide an estimate on how long it will take for a client to complete therapeutic treatment, and much depends on the individual client and their goals in seeking therapy. Some clients are satisfied with a reduction in symptoms while others continue longer because it feels beneficial to do so. Others begin to schedule less frequently, and may continue to come in for “tune ups” or when issues arise. Ultimately, as the client, it is your decision when to stop therapy. As this is a new requirement we are doing our best to full fill and provide the proper information.

Estimate for individual therapy:

The following is a detailed list of expected charges for individual psychotherapy. The estimated costs are valid for 12 months from the date of the Good Faith Estimate. These also include the initial intake fee. Some clients may have a reduced rate and those rates will continue to be the same.

Provider estimates:
$150.00 for a Psychotherapy intake and initial consult–only one required
$120.00 for each Psychotherapy, 60 min, individual session

Primary service and service code:
90791-Psychotherapy intake and initial consult
90837-Psychotherapy, 60 min, individual session

Yearly cost:
Weekly 60 minute individual sessions (50 sessions per year)=$6150.00 per year
Bi-weekly 60 minute individual sessions (25 sessions per year)=$3,150.00
Monthly 60 minute individual sessions (12 sessions)=$1,590.00

Estimate for family/couples psychotherapy:

The following is a detailed list of expected charges for Family/couples, psychotherapy, conjoint psychotherapy with the patient present . The estimated costs are valid for 12 months from the date of the Good Faith Estimate. These also include the initial intake fee. Some clients may have a reduced rate and those rates will continue to be the same.

Provider estimates:
$150.00 for a Psychotherapy intake and initial consult–only one required
$130.00 for each 60 minute Family/couples, psychotherapy, conjoint psychotherapy with the patient session

Primary service and service code:
90791-Psychotherapy intake and initial consult
90847-Family/couples, psychotherapy, conjoint psychotherapy with the patient present

Yearly cost:
Weekly 60 minute couple/family sessions (50 sessions per year)=$6,650.00
Bi-weekly 60 minute couple/family sessions (25 sessions per year)=$3,400.00
Monthly 60 minute couple/family sessions (12 sessions)=$1,710.00

Provider information:

Provider information:
Provider/facility type: Skagit Counseling Center
Address where services will be provided (this includes telehealth clients): 1420 Roosevelt Ave Suite 2 City: Mount Vernon State: WA ZIP code: 98273
Contact person: Taylor Froling
Phone: (360)939-1450
Email: skagitcounselingcenter@gmail.com

Taylor Froling- National Provider Identifier (NPI): 1457554453 Taxpayer Identification Number (TIN): 85-3952110
Marla Johns- National Provider Identifier (NPI): 1639545601 Taxpayer Identification Number (TIN): 85-3952110
Barbara Starr-National Provider Identifier (NPI): 1790849214 Taxpayer Identification Number (TIN): 85-3952110
Maureen Olson-National Provider Identifier (NPI): 1841580693 Taxpayer Identification Number (TIN): 85-3952110

Additional notes:

Additional health care provider/facility notes:
We have a 24 hour cancellation policy. If you do not cancel 24 hours prior to your session you will be charged for the full session. Some clients may be paying a smaller rate than what is listed as above. Those rates will not change.

Disclaimer:

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. This does not include fees if we are required to go to court proceedings.

The information provided in the good faith estimate are estimates and not the final overall total charges.

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. This is not a contract and you are not required to obtain services from the providers listed on this form.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

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 http://www.cms.gov/nosurprises or call HHS at (800) 368-1019.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit http://www.cms.gov/nosurprises or call (800) 368-1019.

Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

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