PRIMARY OFFICE: 620 Longmire Rd, Conroe, TX 77304
Zip Codes: 77320, 77340, 77831, 77873, 77830, 77358, 77331, 77378, 77328, 77303, 77318, 77356, 77868, 77363, 77304, 77301, 77316, 77354, 77375, 77379, 77373, 77302, 77382, 77381, 77380, 77389
ALL PRICES ON THIS "GOOD FAITH ESTIMATE" ARE SUBJECT TO CHANGE
New “No Surprise” Billing Regulations for Behavioral Health Care Providers
The No Surprises Act aims to increase price transparency and reduce the likelihood that clients receive a “surprise” medical bill by requiring that providers inform clients of an expected charge for a service before the service is provided.
Starting January 1, 2022, behavioral health care providers will be required by law to give uninsured and self-pay clients a "good faith estimate" of costs for services when scheduling care or when the client requests an estimate. If you plan on using your insurance, it is the clients responsibility to know your benefits, check how much is your copay, deductible, individual out of pocket, family out of pocket, and number of visits allowed per year. We verify insurance as a courtesy to clients and any benefits quoted to you or to our office by insurance IS NOT A GUARENTEE OF PAYMENT. This means if insurance does not pay, you the client is responsible for payment and can use the "Good Faith Estimate" below to help you know what you might owe.
"Good Faith Estimate" for Uninsured, Private Pay, or Patient Responsibility
-All therapeutic services start with the initial first appointment to complete formal diagnosis and treatment plan. Prior to the first appointment your estimated diagnosis is F99 - Unspecified mental disorder.
TIN: 46-2057056, Group NPI: 1326488073, Service Address: 620 Longmire Rd. Conroe, TX 77304
-Routine treatment usually starts once a week to no less than once every other week for the first four sessions to build rapport, establish stability, and consistency. You can schedule your first four sessions all at once, after your first appointment. Once you get towards your 4th session, together with your therapist you decide whether to stay weekly, once every 2 weeks, once every 3 weeks, or once a month. Below is a detailed list of pricing per service that may be billed so you can estimate what your treatment may cost. Our job is to help decrease frequency of your visits and increase independent stability. Our business model works ourselves out of a job and gets you to a "call us when you need us basis." Your diagnosis may change after your initial appointment, once we have had a proper opportunity to assess your needs.
-The list of services and cost are estimates for people who do not qualify for sliding scale. If you need financial assistance in paying for services, please contact us to discuss sliding scale or reduced fees. Our providers have a few appointments per month reserved for clients who need assistance. To qualify for sliding scale, you must prove your household income for the last 3 years.
All appointments are for In-Office or Telehealth...
CPT 90791 + 90785 - First Appointment/Clinical Evaluation/Counseling Intake = $200 + $30
CPT 90791 + 90785 - Consults = $200 + $30
CPT 90837 + 90785 - 53 minutes Individual Counseling (by fully licensed therapist) = $170 + $30
CPT 90834 + 90785 - 38 minutes Individual Counseling (by fully licensed therapist) = $150 + $30
CPT 90832 + 90785 - 16 minutes Individual Counseling (by fully licensed therapist) = $125 + $30
CPT 90839 + 90840 - 30 minutes Crisis Session + extended time over 60 minutes (by fully licensed therapist) = $200 + $100 CPT 90847 + 90785 - 26 minutes Family/Couples Counseling with client present (by fully licensed therapist) = $150
CPT 90846 + 90785 - 26 minutes Family/Couples Counseling without client present (by fully licensed therapist) = $150
CPT 90853 + 90785 - 26 minutes of Group Counseling/Education (by fully licensed therapist) = $35
CPT 99051 Additional Administrative Fee for M-Thur. 4:30 pm or later appointments = $15 per hour
CPT 99050 Additional Administrative fee for Fri, Sat, Sun, or Holiday appointments = $30 per hour
CPT 99358 Medical Records = $30
CPT 99080 Additional Special Report Writing or Professional Letters = $100 each
CPT 96130 Psychological Testing = $350 to $1500
CPT 0591T Health and Well-being Coaching = $200
CPT 99080 Form Fill Out = $30 each
In-Office or Telehealth First Appointment (by licensed associate therapist) = Not Available
Individual Counseling (by licensed associate therapist) = $85
Family Counseling with or without client (by licensed associate therapist) = $85
Group Psychoeducation (by a mental health tech) = $25
30 minutes Crisis Session + extended time over 60 minutes (by licensed associate therapist) = $150 + $50
Forensic Services preformed by Stephanie Kosut, LPC-S, CFMHE requires a $5000 retainer and $200 an hour thereafter.
DISCLAIMER This Good Faith Estimate shows the costs of items and services that are reasonably expected for your healthcare 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. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact the healthcare provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to updated 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 healthcare provider or facility, you will have to pay the higher amount. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985- 3059. 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.
Prevail Counseling and Forensic Mental Health Consulting, P.C. © 2013 All Rights Reserved