Good Faith Estimates

As of January 1, 2022 all providers are required to provide a Good Faith Estimate for Health Care Items and Services if you are paying out of pocket for services and do not intend on submitting billing for reimbursement. Our practice is invested in ensuring quality of care and values transparency. Our practice will provide a Good Faith Estimate for anyone who requests one regardless of insurance coverage.

You are entitled to receive a “Good Faith Estimate” of what the charges could be for psychotherapy services provided to you. While it is not possible for a psychotherapist to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual needs and circumstances, and the type and amount of services that are provided to you. 

This estimate is NOT a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here.  There is no change to cost of services and we as therapists determine our costs based on government regulations, this is just a formalized way to notify all patients what their estimated costs of therapy are.  

Disclaimer 

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what we agree to in consultation. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. 

This Good Faith Estimate shows the costs 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. 

This 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. 

Insurance Coverage

Infinity Wellness Center & Consulting is in network for Traditional and PPO Blue Cross and Blue Shield. While we make every effort to ensure that your plan is part of the services covered we request that you also verify in network coverage as well as deductibles and co-pays. We require co-pays and deductibles to be paid at the time of service.

If you do not have mental health coverage through Traditional or PPO Blue Cross and Blue Shield our providers are considered out of network. You may have out of network coverage through your insurance; we are happy to provide the forms needed for you to submit an out of network claim to your insurance upon request. You have many in-network providers and should you choose to go out of network we will do our best to help you navigate this process.

Procedure Codes

Here are a list of common codes used to bill services:

90791: Intake appointment ($150- $250)

90837: 60 minute individual therapy session with provider ($135 - $200)

90834: 45 minute individual therapy session with provider ($70 - $100)

90846: 60 minute family therapy session without the patient ($135 - $200)

90847: 60 minute family therapy session with the patient ($135 - $200)