Good Faith Estimate
Good Faith Estimate of Services for Self Pay or Uninsured Clients
You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your mental health care will cost. Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for services. You have the right to receive a Good Faith Estimate for the total expected cost of services. Your health care provider will give you a Good Faith Estimate in writing at least 1 business day before your service. You can choose any health care provider at your discretion and are not obligated to see Marc Panepinto. This is only an estimate of your potential costs. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
List of Potential Services
Initial Evaluation: (CPT 90791) $220.00
Individual Counseling (CPT 90834) $175.00
Family Counseling (CPT 90847) $200.00
Beyond the initial evaluation ($220.00) you can expect to be seen per session $175.00/$200.00 ($700/$800 per month) or Biweekly ($350/$400). Occasionally, some clients are seen less frequently.
The length of your treatment can vary from several sessions to over one year plus. As a result, this GFE will be in effect up to one year from the date of your first session unless amended otherwise. You have the final say in the length of treatment and are encouraged to discuss with Marc Panepinto. You are free to terminate any time you wish