No Surprises Act (NSA)

The No Surprise Act went into effect in 2022 and states that all health care providers are federally mandated to provide clients who do not use their insurance a Good Faith Estimate. The estimate will expire after one year and it allows for the health care provider and the client to have a therapeutic conversation about fees and what would work best for them. Below you will find a fee schedule which will allow the therapist and client to determine an approximate total of fees the client will pay over the course of one year of treatment. Payment plans are available upon request.

Good Faith Estimate

Fee for Private Pay Service (Number of Sessions Will Be Determined as We Progress)

CPT CODE 90791 Initial Diagnostic Evaluation $210
CPT CODE 90832 Psychotherapy, 16-37 minutes $115
CPT CODE 90834 Psychotherapy, 38-52 minutes $150
CPT CODE 90837 Psychotherapy ≥ 53 minutes (This fee is my hourly rate & used for all prorated calculations as indicated) $150
CPT CODE 90839 Psychotherapy for a Crisis (30-74 minutes) $150
CPT CODE +90840 Psychotherapy for a Crisis (add on code for each additional 30 mins) $115
CPT CODE 90846 Family Psychotherapy without Patient Present, 50 minutes $210
CPT CODE 90847 Family Psychotherapy with Patient Present, 50 minutes $210
CPT CODE 90853 Group Psychotherapy $80
CPT CODE 98966-98968 (Telephone Assessment & Management) Prorated based on the amount of time spent at hourly rate
CPT 98970-98972 Online Digital Evaluation & Mgt (Responding to Email & Text Messages) Prorated based on the amount of time spent at hourly rate
Cancelation Fee Your Therapist Requires a 24-Hour Cancelation Notice. You are Responsible for the Fee of the Appointment Missed
Meeting Fee Attending meetings at an offsite location (IEPs; behavior plan; etc.) Prorated based on the amount of time spent at hourly rate
Production of records/legal fees: $350 per hour
Credit card processing fee: 3.15% + $0.30

Total Estimate: This Good Faith Estimate explains your therapist’s rate for each service provided. Your therapist will collaborate with you throughout your treatment to determine how many sessions and/or services you may need to receive the greatest benefit based on your diagnosis(es)/presenting clinical concerns.

Insurance

I currently accept primary insurance coverage from the following providers:

Anthem Blue Cross/Blue Shield and NV Medicaid. For these in-network services, I collect a co-pay and provide billing services to your insurance company. Please bring a document from your insurance known as Evidence of Coverage (EOC) that states coverage and co-pays. Clients are responsible for all out of pocket costs. For all other providers I am considered out-of-network. Your insurance company may reimburse you for out-of-network services. For these services, I collect a session fee and then provide you a superbill to seek reimbursement from your insurance company. Insurance plans and coverage vary widely. The client is responsible for knowing and understanding their insurance benefits/coverage. Contact your insurance provider directly via their website or by phone to verify your coverage, to request a copy of the plan's evidence of coverage (EOC), to ensure that the services are covered, and which insurance plan(s) are your primary and secondary. The client is responsible for payment of services that are denied or not covered by their insurance plan.

Mindful Matters Counseling Services

Mindful Matters Counseling Services

No Surprises Act (NSA)

Good Faith Estimate

Insurance

I currently accept primary insurance coverage from the following providers: