Good Faith Estimate

    (For Private Pay clients only, who are not seeking reimbursement from their insurance provider.)

    Effective January 1, 2022, a ruling went into effect called the "No Surprises Act" which requires practitioners to provider a "Good Faith Estimate" to individuals who are uninsured or privately pay for services. The Good Faith Estimate (referred to throughout this document as “GFE”) works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for mental health services. The estimate is based on information known at the time the estimate was created. The GFE does not include any “No Show” or “Late Cancellation” appointments. You could be charged more if complications or special circumstances occur and will be provided a new GFE should this occur. If this happens, federal law allows you to dispute (appeal) the total bill if it is more than $400/year, and if you and your provider have not previously talked about the change and you have not been given an updated GFE.

     

    Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care services to receive a GFE of expected charges.

     

    Note: The PHSA and GFE do not currently apply to any individuals who are using insurance benefits, including "out of network benefits” (i.e., submitting superbills to insurance for reimbursement).

     

    Timeline requirements: Providers are required to provide a GFE of expected charges for a scheduled or requested service, including services that are reasonably expected to be provided in conjunction with such scheduled or requested services. That estimate must be provided within specified timeframes: 

    • If the service is scheduled at least 3 business days before the appointment date: no later than 1 business day after the date of scheduling; or
    • If the service is scheduled at least 10 business days before the appointment date: no later than 3 business days after the date of scheduling; or 
    • If the service is scheduled less than 3 business days before the appointment date: a Good Faith Estimate is not required; or
    • If the uninsured or private pay individual requests a GFE: no later than 3 business days after the date of the request.

    Common Services at Core Insights Psychological Group, Inc. 

    • 90791: Initial Psychiatric Diagnostic Evaluation (approx. 45-60 minutes)
    • 90832: Psychotherapy, 30 min (16-37 minutes)
    • 90834: Psychotherapy, 45 min (38-52 minutes)
    • 90837: Psychotherapy, 60 min (53-60 minutes)
    • 90839: Psychotherapy for Crisis (approx. 45-60 minutes) 
    • 90846: Family/Couples Psychotherapy without patient (approx. 45-60 minutes)  
    • 90847: Family/Couples Psychotherapy with patient (approx. 45-60 minutes) 
    • 90853: Group Psychotherapy (approx. 60-90 minutes)

    Common Diagnosis Codes at Core Insights Psychological Group, Inc.

     

    Below are common diagnosis codes at Core Insights; however, the list is not exhaustive. With that said, diagnosis codes can change based on many factors. Please speak to your provider with any questions or concerns. 

    • Adjustment Disorder (F43.xx) 
    • Depression (F32.xx)
    • Anxiety (F41.xx)
    • Post Traumatic Stress Disorder (F43.xx)
    • Bipolar Disorder (F31.xx)
    • ADHD (F90.xx)

    Core Insights recognizes every individual’s mental health treatment journey is unique and personalized. How long you engage in mental health services and how often you attend sessions will be influenced by many factors, including, but not limited to: 

    • Your schedule and life circumstances
    • Your provider’s availability 
    • Ongoing life challenges
    • The nature of your specific challenges and how you address them
    • Personal finances

    You and your provider will continually assess the appropriate frequency of services and will work together to determine when you have met your goals and are ready for discharge and/or a new "Good Faith Estimate" can be issued should your frequency or needs change.