Good Faith Estimate

Daphne Fatter, Ph.D.
Licensed Psychologist
2600 Eldorado Parkway, Ste. 230 McKinney, TX 75070; 469-320-9668
NPI# 1497033476 EIN # 47-4941458

Good Faith Estimate for Individual Psychotherapy

Starting January 1, 2022, Federal law requires mental health providers to provide an estimate of costs of services to private pay clients known as a "good faith estimate".

My Private Pay rate is $175 for 55 minute session.

This estimate is the range of costs that is likely for most new private pay patients. Until I do an initial evaluation and we start to work together, I will not have a clear picture of your specific diagnosis, issues and needs. I typically see therapy patients for a time period ranging from 10 sessions - 30 sessions for a total cost ranging from $1750 - $5250. I typically see clients on a weekly or twice a month basis until the clinical issues are resolved and/or functioning has improved. But in some cases a patient’s issues may be more complicated and/or current stressors may exacerbate, so we may need additional sessions during the time covered by this estimate.

Typical Diagnosis I treat include (but not limited to):
Adjustment Disorders
Anxiety Disorders including Generalized Anxiety Disorder and Panic Disorder.
Depressive Disorders including Major Depressive Disorder, Bipolar and Related Disorders.
Trauma and Stressor- Related Disorders including PTSD, Acute Stress Disorder and Adjustment disorders.

Disclaimer

This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your mental health care needs. The estimate is based on the information known to me when I conduct the estimate. When we meet, my initial intake process typically takes 1-2 sessions during which we we formulate a treatment plan based on your diagnosis, current functioning, current stressors, and systemic stressors, which will help guide a more informed plan for our therapy.

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, I will give you a new estimate for services.

This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above. The information provided in the Good Faith Estimate is only an estimate, as actual items, services, or charges may differ.

Your Rights

Federal law allows you to dispute (appeal) the bill if its over $400 of the most current estimate. Thus, If you are billed $400 or more than the most current Good Faith Estimate, you have the right to dispute the bill.

You may contact Daphne Fatter, Ph.D. at the contact listed above to let me know the billed charges are higher than the Good Faith Estimate. You can ask me to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also 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 have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, 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 CMS at 1-800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.