Good Faith Estimate
PURPOSE
This Good Faith Estimate is intended to provide you with an estimate of the charges you'll incur at John Watkins Psychotherapy PLLC. Uninsured and self-pay clients are entitled to Good Faith Estimates as of January 1st, 2022, under the No Surprises Act.
YOUR PROVIDER
John Watkins, LPC-A (#99534), NPI: 1750273801
Supervised by: Damilola Adesina, LPC-S (#78225)
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THERAPIST FEE STRUCTURE
Your therapy will include an initial evaluation session and follow-up sessions. If you have any questions about your upcoming appointment, please don't hesitate to reach out before your visit.
The total cost of your care will include the initial visit, plus any follow-up visits, and will be paid as you go. Initial sessions are 1 hour, and follow-up sessions are typically 50 minutes. If you require more than a 50-minute follow-up session, you will be charged for each additional 15 minutes the appointment runs past the typical time. The number of visits will vary based on your situation and goals, which will be discussed during your initial session with your therapist.
Common Treatment Codes and Cost
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Initial Evaluation-Individual-60m (90791): $135
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Initial Evaluation-Couple-60m (90847): $145
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Follow-up Sessions -Individual-50m (90834): $125
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Follow-up Sessions -Couple-50m (90847): $135
Common Diagnosis Codes
These are common diagnosis codes; however, this list is not exhaustive. Your therapist will ensure a comprehensive evaluation before rendering any diagnosis.
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Adjustment Disorder (F43.23)
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Social Anxiety Disorder (F40.10)
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Depression (F32.0-F33.3)
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Generalized Anxiety Disorder (F41.1)
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Bipolar Disorder (F31.9)
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PTSD (F43.10)
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OCD (F42.9)
ESTIMATED TOTAL COST
Use the above menu of services and their associated costs to calculate the estimated cost of therapy using the following suggested formulas.
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Research indicates that clients typically see results from therapy within 12 sessions, depending on their presenting issue and treatment goals.
12 Sessions = Initial Evaluation Cost + (11 x Follow Up Session Cost)
Many clients see a benefit in long term therapy, upwards of one year or more.
One year of weekly therapy = Initial Evaluation Cost + (51 x Follow Up Session cost)
DISCLAIMER
This Good Faith Estimate shows the costs of items and services that are reasonably expected based on your therapy needs. The estimate is based on information known at the time the estimate was created. It 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.
This Good Faith Estimate is not a contract and does not require you to obtain the services or items from the providers or facility identified in it. You have the right to request another Good Faith Estimate at any time during your course of care.
If the actual billed service charges exceed this estimate by $400 or more, then you (the patient) have the right to dispute the bill via the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS).
Please contact John Watkins Psychotherapy PLLC BEFORE entering the dispute process, as we can usually get the issue resolved.
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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059