Payment Details

Good Faith Estimate Disclosure

& The 'No Surprises' Act

Mosaic Family Counseling Center Inc., demonstrates our commitment to the quality of service and care you receive. You have the right to receive a "Good Faith Estimate" of costs, explaining how much your medical care will cost. Although this page serves as the good faith estimate, please feel free to request one with your service agreement.

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Support. Compassion.

No Surprises Act - Health Care Costs

When you do not use insurance to pay for your care.

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, visit www.cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227)

We are providing you a good faith estimate of costs for services. Although your costs will depend on the amount of your co-pay or deductible, our charges are based on the amount of time we spend with you per session, regardless of diagnosis.
After you see your therapist, they will give you a good faith estimate that includes the duration of treatment expected and possible costs, depending on your situation.
It is impossible to give an exact amount that therapy will cost you, as the final amount will depend on the amount of time you are in therapy and how often you see your therapist.
We are required to charge by code which depicts the amount of time the session lasts. Below is a list of the session time and cost per session.
If you are a private pay client, these are the charges for these services. If there are different services requested, you will receive a more detailed estimate when you meet with your provider.

60-80 min 90791– 265.00 – First appointment/Intake
53-60 min 90837 – 200.00 - Individual
38-45 min 90834 – 155.00 - Individual
23-30 min 90832 – 105.00 - Individual
38-40 min 90846 – 200.00 - Family Session
53-60 min 90847 – 225.00 - Family Session
45-120 min 90853 – 85.00 – Group Session

If you are using insurance to pay for services, the amount for each service will depend on the amount you are required to pay before your insurance will pay for the service. Each insurance company has a different max they will pay for each service. It is your responsibility to understand your insurance and what they will pay, what your responsibility is and if they pay us directly or send you a check.

If they send you a check and we are paneled with your insurance, you are still required to pay us and then you are reimbursed. All services must be paid for at the time of service. If we must generate a statement and mail it to you, there is a $2.00 fee plus the cost of postage for that statement.

If you have a high deductible insurance plan, we are required to charge you the contracted amount if we are paneled with your insurance company. This rate will be given to you upon your first appointment with your therapist.

You are provided with a patient portal, through which you may receive your statements and pay your bill, at the time of service or before.

Our ability to be accurate in predicting the amount services will cost you will depend on the accuracy of the verification of our insurance company’s disclosure of your out-of-pocket costs and where you are in meeting those responsibilities.

Costs Example

Example: 1 year of therapy costs

Example: 1 year of therapy private pay client.

If weekly services: 200.00 x 48 weeks (if no appointments are missed) $9600.00

If bi-weekly services: 200 x 24 weeks $4800.00

If weekly for 3 months (200x12), bi-weekly for 3 months (200x6) and monthly thereafter(200x600): $4800

Low Fee Program

We also have the option for you to work with an intern therapist for a short-term period, this fee is specific for those with no insurance and are involved with the court system, at the following costs.