Pri­vate Pay

• 50-minute ses­sion: $165

Out of Net­work

• I can pro­vide a super­bill to you, where you can then sub­mit a CMS 1500 to file with your insur­ance for pos­si­ble reim­burse­ment or may con­tribute to 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.

Accept­ed Insur­ance

• Aet­na
• Deseret Mutu­al Ben­e­fit Admin­is­tra­tors
• EMI
• Regence (Blue Cross Blue Shield)
• Unit­ed­Health­care

Pri­vate Pay

• 50-minute ses­sion: $165

Out of Net­work

• I can pro­vide a super­bill to you, where you can then sub­mit a CMS 1500 to file with your insur­ance for pos­si­ble reim­burse­ment or may con­tribute to 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.

Accept­ed Insur­ance

• Aet­na
• Anthem (Blue Cross Blue Shield)
• Unit­ed

Pri­vate Pay

• 50-minute ses­sion: $165

Out of Net­work

• I can pro­vide a super­bill to you, where you can then sub­mit a CMS 1500 to file with your insur­ance for pos­si­ble reim­burse­ment or may con­tribute to 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, text, email, or leave a mes­sage for the clin­i­cian 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 10 AM and 5 PM Mon­day through Thurs­day (exclud­ing hol­i­days)
• Calls received after 5 PM or on a week­end or day where the clin­i­cian is not in the office will be received and addressed 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