Good Faith Estimate.

General Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the "No Surprises Act," which required mental health practitioners to provide a "Good Faith Estimate" (GFE). The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your mental health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. In compliance with the No Surprises Act, we are required to notify all of our clients of their Federal rights and protections against “surprise billing."

We are required to provide you with a Good Faith Estimate, or “GFE”, which contains the cost of services for the duration of your therapy with The Hope Preserve, LLC. Although we cannot determine the exact cost of treatment for your mental health care, we have provided our best estimate based on assumed regular weekly attendance at therapy sessions.

This Good Faith Estimate is intended to provide you with an estimate of the charges you'll incur with The Hope Preserve, LLC.

A GFE is only an estimate. The final cost of services billed to you depends on your treatment plan, goals, attendance, and progress with your clinician, and may differ from the estimate.

The total cost of your care will be paid as you go, as you individually choose to schedule and attend each session. The number of visits will vary based on your particular situation and goals, which will be discussed during your intake session.

The fee for a psychotherapy visits are listed for each provider via the scheduling system on our website. Prices range depending on clinician training, licensure, and experience. The cost is $75-$250 for 50-minute sessions with the CPT code of 90834. The fee for a 75-minute psychotherapy visit ranges from $112.50-$375 per session, and is recommended but not required for trauma-processing sessions. The CPT code for 75-minute sessions is 90837.

We have also provided our schedule of fees that you may incur, in addition to direct counseling services and fees. These fees may occur due to the following (not an exhaustive list):

- Late cancellation/no show fees - Full Fee: $75-$250 for 50-minute sessions and prorated for longer-scheduled sessions

- Copies of Medical Records released to medical/legal/etc professionals - $20 for the first five pages + .50 per page after the first five pages + cost of mailing (or as prescribed by current state/federal statutes)

- Completion of documents (summary letters, etc) - $75-$250/hr, based on your therapist’s hourly rate, billed in 15-minute increments

- Trial, Court Ordered Appearances, Litigation, or similar (including the time for communication with you or attorneys after receiving requests or subpoenas about legal matters) - it is generally not recommended that you involve your therapy process in legal matters, but if you choose to do so or are subpoenaed to do so, the fee is double the current publicly advertised rate for your therapist, billed in 15-minute increments.

Diagnosis - in general on Good Faith Estimate forms, a diagnosis may be recorded along with the information provided below, but it's impossible and unethical to diagnose you without having met you, or without your consent, so if you would like a diagnosis, please initiate a conversation with your therapist about whether and how you meet the criteria for a clinical diagnosis. Your diagnosis does not determine the number of sessions you will need.

Most clients will attend one 50-minute or 75-minute psychotherapy visit per week, for at least six months to one year, but the frequency and length of psychotherapy visits that are appropriate in your case may be more or less often than once per week, depending upon your needs and requests. Based on an example advanced therapist with a fee of $195/$292.50 per visit, the following are expected 6-month and yearly charges of psychotherapy services, as well as other charges you may incur:

- $4680/$7020 for 24 sessions (50-minute/75-minute), approximately half a year, assuming two weeks of breaks

- $9360/$14400 for 48 sessions (50-minute/75-minute), approximately a year, assuming four weeks of breaks

During the course of therapy, you may be subject to additional costs based on time, frequency, and services rendered. Please refer to our fee structure above for potential additional services.

The Hope Preserve, LLC recognizes every client’s therapy journey is unique. How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including:

●      Your schedule and life circumstances

●      Therapist availability

●      Ongoing life challenges

●      The nature of your specific challenges and how you address them

●      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 “Good Faith Estimate” will be issued each year in January. You may also request a new GFE at any time in writing during your treatment.

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You have the freedom to choose, every step of the way, appointment to appointment. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

GFE Required Disclaimer:

You have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate. 

Upon your request, or in the case of a crisis, additional services may be required or desired. You’ve been provided with the list of services and fees as part of your informed consent. 

The services will be provided by clinicians of The Hope Preserve, NPI 1649034745, EIN 93-4254100 in-person or online in Tennessee.

Separate good faith estimates will be issued to you upon request. You can request good faith estimates verbally during sessions or via secure message. 

If there is an update to the charges for services, we will provide you with 30 days notice of the change of fee and provide options at your request regarding continuing, transferring, or discontinuing services.

There may be additional items or services your provider recommends as part of psychotherapy that must be scheduled or requested separately not reflected in the good faith estimate;

The information provided in the good faith estimate is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued to the uninsured (or self-pay) individual and actual items, services, diagnosis or charges may differ from the good faith estimate; and

You have the right to initiate the patient-provider dispute resolution process if the actual billed charges are substantially in excess of the expected charges included in the good faith estimate, as specified in § 149.620; to initiate the patient-provider dispute resolution process, send me a message via secure message; the initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to an uninsured (or self-pay) individual by a provider or facility; and

This good faith estimate is not a contract and does not require you to obtain the items or services from any of the providers or facilities identified in the good faith estimate.