GOOD FAITH ESTIMATE

The Federal No Surprises Act & Your Right to a Good Faith  Estimate

​The No Surprises Act requires health care providers and health care facilities to inform individuals who are uninsured or who are seeking services outside of their insurance plan to receive, both orally and in writing, a “Good Faith Estimate” (GFE) of expected charges. The GFE shows the costs that are reasonably expected for services provided. The estimate is based on information known at the time the estimate was created. ​

 

The Good Faith Estimate is not a contract. The number of visits that are appropriate in your case and the estimated cost for those services depends on your needs and what you agree to in consultation with your provider. You are not obligated to receive services at this facility or by this provider. You are entitled to disagree with any recommendations made to you concerning your services and you may discontinue treatment at any time. Our office can provide you alternative referrals at your request.
 

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). 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 only have to pay the price on the Good Faith Estimate. If the agency disagrees with you, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019. Keep a copy of the Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.

 

You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in the Good Faith Estimate.

 

Hourly rate: $250/hour

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SERVICES:

PSYCHOLOGICAL EVALUATIONS

Psychological evaluations are conducted to provide information to parents, schools and other professionals regarding a child’s strengths/weaknesses, diagnoses and potential interventions.  The evaluations can answer diagnostic questions about ADHD, Learning Disabilities, Autism Spectrum Disorders, Depression, Anxiety and processing disorders.

 

 

LIMITED ASSESSMENT

Purpose:  Identify social-emotional, behavioral and developmental issues of the student.

Assessment includes:

• Interviews with parents and student

• Direct testing of student’s social and emotional functioning

• Behavior forms completed by parents and teachers

• Consultations with other professionals (as needed)

• Review of records (as needed)

• Scoring and interpretation of testing data

• Written summary of testing results

• Feedback session to review results and recommendations

Total time: 6-10 hours

Cost: approximately: $1,500 to $2,500

 

 

COMPREHENSIVE PSYCHOLOGICAL ASSESSMENT

Purpose:  Identify cognitive strengths and weaknesses, social-emotional, behavioral

and developmental issues of the student, as well as processing skills.

Assessment includes:

• Interviews with parents and student

• Direct testing of student’s cognitive and processing skills

• Direct testing of student’s social and emotional functioning

• Behavior forms completed by parents and teachers

• Consultations with other professionals (as needed)

• Review of records (as needed)

• Scoring and interpretation of testing data

• Written summary of testing results

• Feedback session to review results and recommendations

Total time: 11-14 hours

Cost: approximately: $2,750 to $3,500

 

 

COMPREHENSIVE PSYCHO-EDUCATIONAL ASSESSMENT

Purpose:  Identify cognitive and academic strengths and weaknesses, social-emotional,

behavioral and developmental issues of the student, as well as processing skills.

Assessment includes all elements of comprehensive psychological assessment plus:

• Direct testing of student’s academic skills

• Written summary or comprehensive report of testing results

• Feedback session to review results and recommendations

Total time: 14 -20 hours

Cost: approximately: $3,500 to $5,000

 

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EDUCATIONAL CONSULTATIONS

Purpose:  Provide parents information and guidance to be a strong advocate for their child and obtain necessary accommodations and/or special education services through the school district and in the community.

Educational Consultations may include:

• Interviews with parents and student

• Review and analyze previous evaluations and school records

• Interpret findings of previous evaluations to parents

• School-based behavioral observations (as needed)

• Attendance at meetings including Student Study Team, 504-Accommodation Plan

and IEP meetings

• Written summary of observations/recommendations

• Expert testimony at fair hearings and due process hearings (as needed)

Total time and cost are determined on a case-by-case basis at the hourly rate of $250

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