Notice to clients and prospective clients

The “No Surprises Act” & Good Faith Estimate (GFE)

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 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, speak to Sophia or visit www.cms.gov/nosurprises

As per Sophia’s Practice Policies, regardless of diagnoses or length of services, the standard fees for in-person rendered at the address above, and tele-behavioral health therapy services are as follows:
90791- Initial intake session consisting of 53-60 minutes is $175.00 (Effective 10/1/24)

90838 for Crisis Intensive session is $175.00 for first 60 minutes (Effective 10/1/24)

90837- 53-60 minute Psychotherapy session is $140.00 (Effective 10/1/24)

90834- 38-52 minute Psychotherapy session is $130.00 (Effective 10/1/24)

Non-Therapeutic/Other Fees:
Late cancelation fee (less than 24 hours advance notice) is $75 (Effective 10/1/24)

No-show/No notice fee is $140 (Effective 10/1/24)

Your annual estimated costs for services will vary based on frequency of sessions, length of time in treatment, and commitment to treatment.

Annual costs can vary for example:

Weekly sessions of $140 for 52 weeks and the one-time intake $175 would average $7,355 per year.

Bi-weekly sessions of $140 for 26 weeks and the one time intake of $175 would average to $3,815 per year.

*These estimate do not include late/no show fees.

*These estimates do not include fees for court appearances should they be required.

Disclaimer

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. The 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.

The good faith estimate is only an estimate and that actual charges may differ, you as the patient have the right to initiate the patient-provider dispute resolution process if the actual bill charges substantially exceed the expected charges in the good faith estimate, and that the good faith estimate is not a contract and does not obligate, you, the patient to obtain the items or services from any of the providers identified in the good faith estimate.