No Surprises Act & the Good Faith Estimate
To honor your privacy and allow you to benefit from specialized services through Thrive Therapy, Inc., we are not in network with any insurance companies and are self-pay only. We can supply you with a Superbill to submit to your insurance company for possible reimbursement, though reimbursement is not guaranteed. For insurance companies to determine if reimbursement is possible, they will require mental health diagnoses regardless of the client’s reason for attending therapy. This diagnosis will stay on your record as a pre-existing condition and could impact future health coverage. We ask our prospective clients to research possible out-of-network (OON) benefits prior to beginning treatment, and to understand regardless of the OON benefits, that you will be responsible for 100% of the session fee at the time of the appointment.
By Thrive having a self-pay practice, our patients know exactly what the cost of services are without surprises later. You are billed session-by-session, and only after reading and signing our Informed Consent and Financial Agreement forms as well as having a clear understanding of pricing before we ever schedule an initial Intake evaluation. You agree to pay out-of-pocket for all sessions at the time of service, which will be verbally discussed as well as outlined in writing for you.
The Good Faith Estimate cannot predict additional fees, including but not limited to, legal fees, missed appointment fees, medical record requests, etc. Please know Thrive has always valued 100% transparency with all aspects of treatment, including billing.
This Good Faith Estimate is provided by:
Thrive Therapy, Inc.
Tax ID/EIN: 825482750
Providers:
Jennifer Simpson- NPI 1184781098
Christina Hall-NPI 1528093325
Services will be provided via telehealth to clients who are physically located in Ohio, Kentucky, or New York at the time of service.
Common Services at Thrive Therapy, Inc.:
90791: Psychiatric Diagnostic Interview
90837: 50 minute Psychotherapy session
90853 : Group Psychotherapy Session
+99354: Prolonged service/outpatient service (additional 30 min for PE sessions)
Common Diagnostic Codes at Thrive Therapy, Inc.:
- Post-Traumatic Stress Disorder: (PTSD) 81 (F43.10)
- Other Specified Trauma and Stressor-Related Disorder: 309.89 (F43.8)
- Unspecified Trauma and Stressor-Related Disorder: 309.9 (F43.9)
- Major Depressive Disorder: Single Episode- 296.21 (F32.0) Mild, 296.22 (F32.0) Moderate, 296.23 (F32.2) Severe, 296.24 (F32.0) With Psychotic Features, 296.25 (32.4) In Partial Remission, 296.26 (F32.5) In Full Remission, 296.20 (F32.9) Unspecified
- Major Depressive Disorder, Recurrent Episode: 296.31 (F33.0) Mild, 296.32 (F33.1) Moderate, 296.33 (F33.2) Severe, 296.34 (F33.3) With Psychotic Features, 296.35 (F33.41) In Partial Remission, 296.36 (F33.42) In Full Remission, 296.30 (F33.9) Unspecified
*Note: cost of sessions do not change based on diagnosis.
How often and for how long you’ll engage in treatment can be influenced by several factors, including what you are being treated for, what treatment protocol you decide on with your therapist, your schedule, and if you decide to have as-needed follow-up with your therapist once a treatment protocol is completed.
Below is a breakdown of expected fees based upon frequency/duration of treatment at our current rates.
Chart A represents a patient who attends 1- 90-120 minute initial Intake assessment ($300.00), the standard 12- 55 minute Cognitive Processing Therapy (CPT) sessions ($200.00), and 1- 55 minute post-treatment 1-month follow-up session ($200.00).
| Initial Intake Assessment (90791) | 1 | $300.00 | $300.00 |
| 55 minute therapy sessions (90837) | 12 (weekly) 1 (1-month f/u) | $200.00 | $2600.00 |
Total Estimated Charges: $2900.00
Chart B represents a patient who attends 1 90-120 minute initial Intake assessment ($300.00), the standard 10- 90-minute Prolonged Exposure Therapy (PE) sessions ($275.00), and 1-post-treatment 1-month follow-up ($200).
| Initial Intake Assessment (90791) | 1 | $300.00 | $300.00 |
| 90 minute therapy sessions (90837 + 99354) | 10 (weekly) | $275.00 | $2750.00 |
| 55 minute therapy sessions (90837) | 1 (1-month f/u) | $200.00 | $200.00 |
Total Estimated Charges: $3250.00
Should a client choose to continue care with their provider, the frequency and duration will be discussed. Chart C represents a patient who chooses to continue with 55-minute sessions ($200.00) at an average of every other week for a year.
| Initial Intake Assessment (90791) | 1 | $300.00 | $300.00 |
| 55 minute therapy sessions (90837) | 26 (every other week) | $200.00 | $5200.00 |
Total Estimated Charges: $5500.00
An updated estimate will become available when/if clients change the frequency of their appointments or should the session fees change.
This is not a contract, and therapy may be discontinued at any time. Please let your provider know should you have any questions or concerns regarding billing.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, healthcare 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 healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare 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.
Get More Information For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises
