Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act,” which requires mental health practitioners to provide a “Good Faith Estimate” (GFE) about out-of-network care to any patient who is uninsured or who is insured but does not plan to use their insurance benefits to pay for health care items and/ or services.

You either have chosen individual, couples or group therapy sessions.

Individual Therapy Sessions cost $150 per session and are charged day of session.

Couples Therapy Sessions cost $180 per session and are charged day of session.

Group Therapy Sessions cost a range of $50 to $100 per individual in the group therapy session and are charged the day of session.

How often you decide to receive support in a therapeutic manner for psychotherapy is decided upon with the client and therapist (Chelsea Frank, LPCC and client). With more support needed, therapy can reach up to 2x per week in more critical times in a person’s life to 1X per week to bi-weekly to every 3 weeks to once a month for some clients. There are health-related reasons for cancellations (of course there is always telehealth as an option if you are sick, but still want to come to therapy or are able). Other cancellations can occur so to factor that in when you calculate your annual expense for therapy as well as if and what your insurance covers for mental health. It is your responsibility to seek information from your insurance about what mental health coverage you have as well as to send your insurance the Superbills given to you from Butterfly Counseling Company PLLC and Chelsea Frank, LPCC.

Under the law, Health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. This is called a Good Faith Estimate.

• You have the right to receive a Good Faith Estimate for total expected cost of any health care items of services. The Good Faith Estimate shows the total expected cost of any non-emergency items or services and equipment.
• You may request a Good Faith Estimate in advance of an already scheduled health care service or item, or before scheduling an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

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.