GOOD FAITH ESTIMATE

GOOD FAITH ESTIMATE

This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified in here.

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You are entitles to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

The fee for a 50 minute psychotherapy visit (in person or via telehealth) initial session is $155.00, each follow up session is $100.00. Most clients will attend one psychotherapy visit per week, but the frequency of psychotherapy visits that are appropriate in your case may be more or less than once per week, depending upon your needs. 

Based upon a fee of $100.00 per visit, if you attend one psychotherapy visit per week, your estimated charge would be $400.00 for four visits provided over the course of one month; $800.00 for eight visits over two months; or $1200.00 for 12 visits over three months.  If you attend therapy for a longer period, your total estimated charges will increase according to the number of visits and length of treatment.

One session per week for one year would equal $5200. 
Two sessions per week for one year would equal $10,400.

Please let your therapist know if you no longer need services, or if you would like to decrease the frequency of services.

You have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400.00 or more beyond the estimated charges).

You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan. You have the right to speak with our Billing Manager, Jenn Maher, if you have questions regarding your Good Faith Estimate.  You have the right at any time to terminate or end sessions.

In the case where FCYFC is the Provider for a child, we recommend at least one child (individua) session and one family (parent or guardian with or without the child) session per week.  This would give you the two session per week estimate.

Payment is due the day of each session.  If an appointment/session is canceled late (less than 24 hours notice), or if you "No Show" for an appointment/session, the fee is $100.00. 

​A credit card is required to keep on file.
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