Financial Policies & Good Faith Estimate

Good Faith Estimate

The purpose of this document is to make sure that you are fully informed about our fees and financial policies and to comply with a 2022 federal law called the “No Surprises Act.” The intention of this law is to protect consumers from large, unexpected medical bills (e.g., after a hospital visit) in the wake of the COVID-19 pandemic. Under this law, you are entitled to receive this “Good Faith Estimate” of the cost of our services. This estimate is not a contract and does not obligate you to obtain any services from us, nor does it include any additional services that may be recommended during the course of your treatment. In addition, we also explain in this document various important financial policies. Please review it carefully.

This estimate is not intended to serve as a recommendation for treatment or a prediction that you may need a specified number of psychotherapy sessions. Indeed, it is not possible for us to know in advance precisely what services you may need or how many sessions may be required. Therefore, this document will simply outline our fees, your potential costs over time, and then review our financial policies. The actual cost of services will depend on your individual circumstances, the type and amount of services we recommend, and the total number of
sessions you attend. Of course, you are free to disagree with our treatment recommendations and/or discontinue treatment at any time.

***NOTE: This estimate expires at the end of the current calendar year.***

Financial Policies & Fees:

For all clients, 45-50 minute sessions of individual, couples, or family therapist cost:

-$120 for providers: Luke Brown, LPCC, Steven Armour, LPCC-S, Rachel Dollard, LISW-S, Kevin Norris, LPCC-S
-$150 for provider: Nicole Melchi, LPCC-S, CGT, IMFT

Some clients opt for shorter (25 minute) or longer (75+ minute) sessions. These sessions cost:

-$60 per 25 minute unit for providers: Luke Brown, LPCC, Steven Armour, LPCC-S, Rachel Dollard, LISW-S, Kevin Norris, LPCC-S
-$75 per 25 minute unit for provider: Nicole Melchi, LPCC-S, CGT, IMFT

Per our practice policies, no-shows or appointments cancelled with less than 24-hours notice will be billed the full fee for services.

A credit or debit card are required to have on file regardless of payment method preferred.

NOTE: Checks are generally deposited once per month on the second Saturday of the month.

Records requests:

If a client requests letters, forms, records, or any other form of paperwork to be completed, be advised that there is a fee. These items require time to prepare and deliver. Our rate for preparation and delivery is $100 per hour with a minimum fee of $25. There is also a flat rate of $25 added for printing, shipping, and other office costs. You are able to request an approximate cost to fulfill your records request from your therapist.
Once your records are ready, you will receive an itemized invoice with prep and delivery costs.
Your records will be sent to you within 5-7 days from the time of your request.
We accept cash, checks, and debit/credit cards.

Ongoing therapy costs:

Below are some examples of the potential annual cost for engaging in standard length sessions (45-50 min.) at
monthly, bi-weekly, weekly, and twice weekly frequencies for a full year. Your actual costs will likely differ from
these based on your individual needs.

Monthly
-12 monthly sessions with providers Luke Brown, Steven Armour, Kevin Norris, & Rachel Dollard: $1440
-12 monthly sessions with provider Nicole Melchi: $1800

Biweekly
-26 biweekly sessions with providers Luke Brown, Steven Armour, Kevin Norris, & Rachel Dollard: $3120
-26 biweekly sessions with provider Nicole Melchi: $3900

Weekly
-52 weekly sessions with providers Luke Brown, Steven Armour, Kevin Norris, & Rachel Dollard: $6240
-52 weekly sessions with provider Nicole Melchi: $7800

Twice Weekly
-104 twice-weekly sessions with providers Luke Brown, Steven Armour, Kevin Norris, & Rachel Dollard: $12480
-104 twice-weekly sessions with provider Nicole Melchi: $15600

Payment:

-Payment is due at the time of service.

-Our preferred methods of payment are cash and check. We also accept credit, debit, and HSA cards. However, if you use these methods, you will be charged a processing fee based on the total fees of your appointment equal to 3.15% + $0.30.

Example Fee:
$120 appointment + $4.08 = $124.08

-If you pay with a bank card, our practice management software will save your information to speed future transactions. We will charge your card for subsequent visits unless you tell us not to do so. If your card information changes, please notify us as soon as possible.

-If you become unable to pay for services or begin to accrue a balance, discuss this with us as soon as possible. We will work with you to find a solution. If we are unable to come to an agreement, and you continue to maintain an unpaid balance, we reserve the right to terminate your services.

Insurance:

Sacred Heart Counseling does not participate in any insurance plans, Medicare, or Medicaid. We will not bill insurance companies nor accept reimbursement from them. However, our clients are free to submit their own claims to their health insurance company if they wish to pursue reimbursement for our services.
We can provide only limited assistance in this process. For example, we can provide you with statements (called “Superbills”) that list all the information insurance companies typically need to process a claim. These statements become available a few days after our services were rendered. It is your responsibility to send these statements to the claims department of your insurance company for processing. NOTE: Regardless of whether your insurance company reimburses you, our fees are still your responsibility and payment is due in full at the time of service. Our policy is that the client first pays Sacred Heart Counseling, and any reimbursement from the insurance company goes directly back to the client.

Your rights:

We encourage you to discuss with your therapist any questions you might have about our fees and financial policies. In addition, according to the No Surprises Act, you have a right to dispute your bill if the actual amount charged to you substantially exceeds (i.e., by $400 or more) the estimated charges stated in this Good Faith Estimate. Initiating the dispute process will not adversely affect the quality of services rendered to you. To do so, simply discuss the discrepancy with your therapist and point out that the billed charges are higher than the
Good Faith Estimate. You have several options:

-Ask that your bill be brought in line with the Good Faith Estimate
-Ask to negotiate the bill
-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 this option, you must start the dispute resolution 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, 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. We encourage you to keep a copy of this Good Faith Estimate for your records.