Good Faith Estimate Advisory Notice for Self-Pay clients

*Available upon request

Our fee schedule remains the same whether insurance is filed or whether you are a self-pay client. The fee schedule below serves as the disclosure of expected payment.

You can also ask for a Good Faith Estimate at any time before you schedule 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, visit www.cms.gov/nos

Rates

     Whitney

            Initial Evaluation/Assessment:  $150

            53-60 minute psychotherapy:    $140

     Melody

            Initial Evaluation/Assessment:  $150

            53-60 minute psychotherapy:    $140

     Tiffany

            Initial Evaluation/Assessment:  $150

            53-60 minute psychotherapy:    $140

Insurance

     In-network:

          Whitney - BCBS NC, Anthem of VA, State Health Plan, Blue Options

          Melody - BCBS NC, State Health Plan, Blue Options

          Tiffany - BCBS NC, State Health Plan, Blue Options starting Oct. 15

Please know that filing a claim with your insurance provider is not a guarantee that your claims will be reimbursed. It is suggested to contact your insurance provider and inquire specifically about your plan and what services will be reimbursable.

     Questions to consider asking your provider:

          Do I have mental health insurance benefits?

          What is my deductible and has it been met?

          How many sessions per year does my health insurance cover?

          What is the coverage amount per therapy sessions?

          Is approval required from my primary care physician?

          Is my therapist in-network?

Payment

Full payment is expected at the end of each session unless other arrangements have been made. Session fees are subject to change, but an advance notice of 30+ days will be given.

     Methods of payment include:

          Cash

          Check

          Major credit cards

Cancellation Policy

In the event that you have to cancel, please call the office at 336-777-3615. Please provide a 24-hour notice when canceling an appointment. If not, a fee of $50 will be assessed. Charge for checks returned for insufficient funds is $35.