Good Faith Estimate For Onsite and Telehealth Services
Service | Unit | Service Code | Fee |
Initial Session / Assessment | Couples | 90791 | $225 |
Initial Session / Assessment | Individual | 90791 | $175 |
Marriage Therapy | Couple | 90847 | $200 |
Individual Therapy | Individual | 90837 | $150 |
The Good Faith Estimate is not a bill. The Good Faith Estimate shows the cost of items and services that are reasonably expected for your 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. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
You May contact Nasaba Family Counseling & Consulting Inc., if the billed charges are higher than the Good Faith Estimate. You can ask Nasaba to update the bill to match the Good Faith Estimate, or negotiate the 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 Nasaba you will have to pay the higher amount.
To learn more and get a form to start the process, go to: https://www.cms.gov/nosurprises/consumers
or call 1-800 – 985-3059.