Accepted Insurance

• Aetna
• Deseret Mutual Benefit Administrators
• EMI
• UnitedHealthcare

Private Pay

• 50-minute session: $165

Out of Network

• I can provide a superbill to file with your insurance which may go toward your deductible (dependent on your insurance).

Clergy Pay

• If your LDS bishop or church leader has agreed to pay for some or all of your therapy sessions, please let me know in our initial phone consultation so I can work out the details of payment prior to our first therapy session.

Private Pay

• 50-minute session: $165

Out of Network

I can provide a superbill to file with your insurance which may go toward your deductible (dependent on your insurance).

Clergy Pay

• If your bishop or church leader has agreed to pay for some or all of your therapy sessions, please let me know in our initial phone consultation so I can work out the details of payment prior to our first therapy session.

Private Pay

• 50-minute session: $165

Out of Network

I can provide a superbill to file with your insurance which may go toward your deductible (dependent on your insurance).

Clergy Pay

• If your bishop or church leader has agreed to pay for some or all of your therapy sessions, please let me know in our initial phone consultation so I can work out the details of payment prior to our first therapy session.

You are responsible for cancelling or changing your appointments. BridgeHope Family Therapy’s cancellation policy is as follows:

• You must call with a minimum of 24-hours advance notice to cancel or move an appointment. If you do not give more than a 24-hours advance, you are obligated to pay the full session fee.
• Cancellation calls are taken between 9 AM and 5 PM Monday through Thursday (excluding holidays)
• Calls received after 5 PM or on a weekend will be received the morning of the following business day

In compliance with the No Surprises Act, in effect January 1st, 2022, I am required to notify clients of their Federal rights and protections against surprise billing.

These rights are also outlined at www.cms.gov/nosurprises/ and at www.cms.gov/nosurprises/consumers/new-protections-for-you.

Clients Forgoing Use of Their Insurance or Who Are Uninsured:

You are under no obligation to sign a Good Faith Estimate but I may need to decline treatment if we do not sign an agreement.

Context:

The following section is intended to provide relevant and contextual information about the application of the No Surprise Act and subsequent Good Faith Estimates (GFE) to the field of psychotherapy.

Psychotherapists [broad term for: Licensed Clinical Marriage and Family Therapists, Licensed Clinical Professional Counselors, Licensed Clinical Social Worker Certified] in private practice were under the impression that the No Surprise Act would primarily protect patients from getting surprise and burdensome medical bills such as from the hospital. However, the Act does apply to the field of mental health. Therefore, relevant contextual information is necessary.

Providing a Good Faith Estimate to a clients’ mental health journey is partially unrealistic. Providing a per session fee is reasonable and already ethically required. A clients’ openness to the therapeutic process, speed of response to treatment, severity of condition, changing client goals, healthcare philosophy, value of ongoing support, frequency of treatment, and more all effect the cost of treatment. Psychotherapy is not a one-time procedure like a broken arm that can be easily quoted — and somatic medical procedures were what the Act originally aimed to apply to.

Under certain circumstances of the No Surprises Act, clients can enter a dispute resolution process if costs go too high above the Good Faith Estimate (GFE). Therefore, we need to quote a GFE for an entire year with the highest likely costs factored in. While this has the advantage of helping clients think through and budget for longer-term therapy, it can also force sticker shock on potential clients right at the time when they are most in need — possibly causing them to forgo the help they deserve.

To be clear, many/most clients see relief of their original condition/concerns far faster than a year, and if they stay that long it is because they are finding value working on secondary or different concerns. Clients always have the right to discontinue therapy at any time they are worried about their budget, or discuss budgeting options with their therapist.

There is often an implicit assumption that clients seeing a therapist outside of insurance are being ripped off financially. I believe that sometimes the right provider is not in-network with a client’s insurance. For example, sometimes people want more data privacy than can be assured when insurance is involved. Also, sometimes, particularly in mental health, clients would like to work with a provider who will not be restricted by insurances dictating: diagnoses, treatment timelines (e.g., session length and frequency), modality requirements, etc.

Clients paying out-of-pocket for therapy will be given a GFE based upon the Standard Fee Schedule below. Financial discounts are available on a limited basis.

I invite you to consider the value of your mental health needs and the value of your provider preferences in seeking treatment. Therefore, please reflect on the Good Faith Estimate and available in-network insurance options with a discerning eye. Being an informed consumer is wise on your part.

Background:

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

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items or services.

• You have a right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• You can also get the items or services described in this notice from providers who are in-network with your health plan.

• 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 information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (443)-371-3233.

Estimate:

The following is a detailed list of expected charges for psychotherapy, scheduled for 2022. The estimated costs are valid for 12 months from the date of the Good Faith Estimate, which can be officially provided to you by reaching out through our Contact Us page. The amount below is only an estimate; it isn’t an offer or contract for services. This estimate shows the estimated costs of the items or services listed. It does not include any information about what your health plan may cover. The estimated cost does not factor in other fees. While they are listed for your reference, “other fees” will be discussed with you before charges are incurred.

Private Pay Fee Schedule

• CPT 90834 (38 to 52 minutes individual psychotherapy): $165

• CPT 90837 (53 to 60 minutes individual psychotherapy): $165

• CPT 90791 (75 – 90 minutes): $165

• CPT 90847 (psychotherapy with family member participating): $165, depending on the length of the session

Other Fees:

If you are paying out-of-pocket, the fees to see one of our therapists are as follows:

• Late Cancellation Fee: $165 for 50-minute sessions (A late cancellation is a no-show or cancellation under 24 hours from the scheduled start time of a session for any reason be. This may also be charged if a client is more than 15 minutes late for an appointment.)

• Written Reports & Paperwork (when I agree to write them): $200/hour

• Legal and Court Fees: $200 per hour plus expenses. $1600 retainer in advance for days I am expected in court. Court hours (including travel time) billed in minimum blocks of 4 hours ($800) each. (I will rarely agree to voluntarily participate in legal/court matters.)

Appropriate Range:

The majority of clients seen at BridgeHope Family Therapy attend therapy on a weekly, bi-weekly, or monthly basis.

Therefore, based on the schedule of fees provided ($165/session) and a variety of applicable factors (sick time, vacation time, frequency of sessions, etc.) A Good Faith Estimate of total cost of services provided is:

• Weekly ($165 for 48 weeks): $7920

• Bi-weekly ($165 for 24 weeks): $3960

• Monthly ($165 for 12 sessions): $1980