
KAELY PHELPS THERAPY

Good Faith Estimate
Your Rights and Protections Against Surprise Medical Bills
Under Section 2799B-6 of the Public Health Service Act, healthcare providers are required to provide patients who are not enrolled in a health insurance plan or who are paying out-of-pocket with a Good Faith Estimate of expected charges.
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost before you receive services.
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About Good Faith Estimates for Psychotherapy Services
A Good Faith Estimate is an estimate of expected charges for psychotherapy services. This estimate will be provided to you before your first session and is based on information available at that time, including your presenting concerns and expected treatment plan.
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What the Estimate Includes
The Good Faith Estimate will provide information about:
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The cost of initial consultation/assessment sessions
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The expected cost per therapy session
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An estimate of the frequency and duration of treatment based on your needs
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Total estimated costs for the anticipated treatment period
What the Estimate Does NOT Include
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Services you may choose to add during the course of treatment
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Services that may arise from complications or special circumstances
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Services recommended by other healthcare providers
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ny prescription medications
Understanding Treatment
Costs Variability in Psychotherapy
The actual services and charges may differ from the Good Faith Estimate because:
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Psychotherapy is highly individualized and treatment needs vary
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The complexity of issues may become clearer as therapy progresses
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You may choose to adjust session frequency or duration
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The overall length of treatment depends on your progress and goals
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Attendance patterns and scheduling may vary
Duration and Frequency
The length and frequency of psychotherapy varies greatly depending on individual circumstances:
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Some clients achieve their goals in a brief period
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Others benefit from longer-term therapeutic work
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Session frequency may range from weekly to monthly or as needed
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You maintain full autonomy to adjust or discontinue services at any time
Treatment duration and frequency will be discussed collaboratively based on your therapeutic goals and clinical recommendations.
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Your Rights Under Federal Law Right to Receive an Estimate
Before receiving services, you have the right to receive a Good Faith Estimate that includes:
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Expected charges for scheduled services
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An itemization of services to be provided
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The period of time the services are expected to span
Dispute Resolution Process
If you receive a bill that is substantially more than your Good Faith Estimate (generally $400 or more above the estimated amount), you have the right to dispute the bill.
How to initiate a dispute:
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Submit a notification within 120 calendar days of receiving the bill
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Contact the U.S. Department of Health & Human Services:
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Website: www.cms.gov/nosurprises
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Phone: 1-800-985-3059
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There is a $25 administrative fee to use the federal dispute resolution process, which may be waived in cases of financial hardship.
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Requesting Your Good Faith Estimate
Your Good Faith Estimate will be provided to you:
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Upon scheduling your first appointment
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Before your initial session
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Whenever you request an updated estimate
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If the scope or nature of services changes significantly
You may request a Good Faith Estimate at any time by contacting us.
Payment and Billing Information
Payment Terms
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Session fees will be discussed during the consultation process
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Payment is expected at the time of service unless alternative arrangements are made
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We accept various payment methods including credit/debit/HSA & FSA cards.​
Cancellation Policy
We require advance notice for cancellations or rescheduling. Our cancellation policy will be discussed when you schedule your first appointment and is also outlined in our Terms and Conditions.​
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Additional Resources
No Surprises Act Information:
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Website: www.cms.gov/nosurprises
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Helpline: 1-800-985-3059
For questions about your federal rights:
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U.S. Department of Health & Human Services
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Centers for Medicare & Medicaid Services
Commitment to Transparency
We are committed to providing clear, transparent information about the costs of psychotherapy services. We believe you should have a clear understanding of expected costs before beginning treatment, and we welcome all questions about fees and billing.
Your Good Faith Estimate will be discussed with you before your first session, and we encourage open communication about any financial concerns throughout the course of treatment.