No Surprises Act Good Faith Estimate

A new healthcare law called the No Surprises Act went into effect on January 1, 2022. The purpose of the legislation is to protect healthcare consumers from getting massive surprise bills from healthcare providers. One way it seeks to do this is to require providers to give a “good faith estimate” to those who are uninsured and to those who are insured but are seeing an out-of-network provider.  

As Healing Seeds Therapy PLLCl does not contract with any insurance provider, we are an out-of-network provider for all insured clients. We also see uninsured clients. Just like before, those with out-of-network benefits may be able to submit healthcare receipts for reimbursement according to your specific insurance plan. Just like before, you can also opt out of using your out-of-network insurance benefits and pay out of pocket. 

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.

Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

If  Healing Seeds Therapy PLLC changes its fees, you will be notified at least 30 days in advance and will receive a new good faith estimate prior to the first appointment for which the new fees apply. 

Below is a list of your provider’s session fees. The Diagnostic Assessment is scheduled for the very first session with your provider, or for the first session after a 6-month break from therapy, or for the first session after a closed case is reopened. After that, we most commonly schedule Psychotherapy, 50 minutes. On rare occasions, we will schedule Psychotherapy, 30 minutes, Psychotherapy with a family member, 50 minutes, or Psychotherapy for crisis, 60 minutes. If a crisis session runs longer than 60 minutes, each additional 15 minutes is billed as described in the chart.  You will know at the time of scheduling what type of session is being scheduled. This list does not include administrative fees for third party paperwork or court appearances. Administrative fees are listed in the consent form. 

Service Service Code Fee

Diagnostic Assessment 90791 $160

Psychotherapy, 50 minutes 90834 $140

Psychotherapy, 30 minutes 90832 $80

Psychotherapy w/ family member, 50 minutes 90834 $170

Psychotherapy for crisis, 60 minutes 90839 $150

Psychotherapy for crisis, each additional 30 minutes 90840 $80