GOOD FAITH ESTIMATE
Understanding the cost of your care before you begin — because transparency is part of good therapy.
Effective January 1, 2022, the No Surprises Act requires mental health practitioners to provide a Good Faith Estimate (GFE) to any patient who is uninsured, or who is insured but does not plan to use their insurance benefits to pay for services.
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The GFE shows the cost of items and services reasonably expected for your mental health care. The estimate is based on information known at the time it was created and does not include unknown or unexpected costs that may arise during treatment.
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Your total cost will depend on the number of sessions you attend, your individual circumstances, and the type and amount of services provided. This estimate is not a contract and does not obligate you to obtain any services.
Primary Service
The primary service offered is a 50-minute psychotherapy session, available in-person or via telehealth.
CPT 90837 — Individual
CPT 90847 — Couples / Family
This Good Faith Estimate is not a recommendation for treatment or a prediction of how many visits you may need. The appropriate frequency and duration will be determined collaboratively between you and your therapist. You are entitled to disagree with any recommendations and may discontinue treatment at any time.
Session Fee & Cost Estimate
$150
per 50-minute psychotherapy session (in-person or telehealth)
Most clients attend one session per week, though frequency may be more or less depending on your individual needs and preferences. When planning your total estimate, factor in vacations, holidays, emergencies, and sick time.
Your total cost of services will depend upon the number of sessions you attend, your individual circumstances, and the type and amount of services provided.
How to estimate your cost: Multiply the $150 session fee by your expected number of sessions.
For example: $150 × 4 sessions = $600. Factor in vacations, holidays, and any breaks when planning ahead.
Estimated Cost Timeline
Fees effective January 1, 2025 through December 31, 2025
DURATION OF SERVICE
APPROXIMATE TIME
ESTIMATED COST
1 week of service
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$150
13 weeks of service
approx. 3 months
$1,950
26 weeks of service
approx. 6 months
$3,900
39 weeks of service
approx. 9 months
$5,850
52 weeks of service
approx. 12 months
$7,800
Additional Possible Services & Fees
The following fees may apply depending on circumstances that arise during or outside of your treatment. These items are discussed in detail within the Therapy Consent and Agreements and Practice Policies documentation. Should any of these services be initiated, a new Good Faith Estimate will be provided.
SERVICE
FEE
Late cancellation / no-show
$75 per session missed
Record request
As allowed by law
Consultation with other providers
$150 / billed in ¼ hrs
Letter or report writing
$150 / billed in ¼ hrs
Travel time for court appearances
$150 / billed in ¼ hrs
Forensic and/or legal fees*
$250 / hour
*A separate Good Faith Estimate will be provided for forensic/legal services based on the specific scope of work involved.
Your Therapy Journey
Melanie Palmer LLC recognizes that every client's therapy journey is unique. How long you engage in therapy and how often you attend will be influenced by a number of factors:
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Your schedule and life circumstances
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Therapist availability
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Ongoing life challenges
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The nature of your specific challenges
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How you address those challenges
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Personal finances and resources
You and your therapist will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge. A new GFE will be issued if the frequency or nature of your sessions changes.
You may request a new Good Faith Estimate at any time in writing during your treatment.
Good Faith Estimate Disclaimer
This estimate is based on information known at the time it was created. Your provider may recommend additional services not reflected here. Actual charges may differ from this estimate. You could be charged more if complications or special circumstances occur.
The Good Faith Estimate does not include unknown or unanticipated costs, or costs arising from unforeseen events during treatment.
Other potential items associated with therapy charges may include no-show/late cancellation fees, record requests, letter writing, legal fees/court attendance, professional collaborations, and between-session supports.
Please note: The Good Faith Estimate does not obligate you to obtain any of the listed items or services.
Your Rights & the Dispute Process
If your bill is $400 or more than this Good Faith Estimate for the same provider or facility, federal law allows you to dispute the bill.
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Speak with your provider. You may ask them to update the bill, negotiate, or inquire about financial assistance.
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Start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days of receiving the bill.
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Pay the $25 filing fee to use the federal dispute process.
While your dispute is open: the provider cannot send the bill to collections, must pause late fees, and cannot retaliate against you.