Good Faith Estimate

Background

Federal legislation passed in 2020 to protect patients from unexpected healthcare bills. The No Surprises Act (NSA) requires that Good Faith Estimates (GFEs) be provided for medical items and services. These GFE disclosure requirements took effect on January 1, 2022, with enforcement by the Department of Health and Human Services (HHS) beginning the same year.

Provider Requirements

Therapists at Red Lotus Counseling & Wellness are required under the 2022 No Surprises Act to provide you with a Good Faith Estimate of the expected cost of treatment if you are uninsured or choose not to use insurance for your care.

Insurance

Until it is determined whether you will be using insurance or opting for self-pay, the information provided below reflects our standard “fee-for-service” (out-of-pocket) rates.

If you plan to use insurance, please contact your insurance provider to confirm your copayment, coinsurance, and any deductible details. Your out-of-pocket costs through insurance are typically lower than the self-pay rates listed here.

Assessment

Because your symptoms and concerns have not yet been formally evaluated, this estimate is based on the national average for a standard course of psychotherapy, which typically includes 18 sessions.

This initial estimate is valid for 12 months from the date of this document. However, you are welcome to request an updated estimate at any time as your treatment needs or plans evolve.

Good Faith Estmiate

Current ICD-10 Diagnosis: R69 (Diagnosis Deferred)

Anticipated Treatment Plan:

1 session of CPT 90791 (Diagnostic Evaluation) — [$150.00]
17 weekly sessions of CPT 90837 (Psychotherapy, 60 minutes) — [$120.00 per session]

Estimated Total for Services (Without Insurance): [$2,190.00]

Please note: This is a general estimate based on national averages. The actual duration and cost of your treatment may vary depending on your individual symptoms, progress, work between sessions, and response to treatment.

Client Rights & Treatment Flexibility:

You are free to modify or discontinue treatment at any time unless otherwise required by a court order (a rare circumstance). You are encouraged to discuss any preferences regarding treatment approaches, session frequency, or duration. Your healthcare is ultimately your choice — we are here to support you in the ways that are most helpful for you.