Good Faith Estimate for Healthcare Items and Services
The following is a detailed list of expected charges from BARON COUNSELING SERVICES LLC. The estimated costs are valid for 12 months from the date of the Good Faith Estimate.
(Insurance Does Not Cover All Services) Prices and availability are subject to change without prior notification. We are committed to delivering exceptional services to all, including those who are uninsured and have to pay out of pocket. We are pleased to provide a sliding scale fee to those who meet the criteria. A sliding scale discount is provided in accordance with the size of the family or household and the income of the household.
Therapy Services (45-60 minutes sessions)
- 90834- 90837: Individual $125 per session, (1) unit
- 90847: Premarital/Couples Therapy $175 per session, (1) unit
- 90849: Family/Group Therapy $175 ($30 each additional person)
- 90880: Hypnotherapy $225 per session, (1) unit
- 90899: EMDR $225 per session, (1) unit
- 99401-99404: Sex therapy (preventative) $225 per session, (1) unit
- G0445: Sex therapy (intensive) $225 per session, (1) unit
Assessments (Note: assessments fees do not include ongoing routine therapy sessions)
- Anger Management Assessment $265 (Certificate included per completion)
- Substance Abuse Assessment $265 (Certificate included per completion)
- Premarital Assessment $265 (Certificate included per completion 4/hr. course)
- Bariatric Pre-Surgical Evaluation & Letter $250
- Mental Health Assessment $225 Emotional Support Animal Assessment & Letter $250 Hypnosis Assessment & Treatment $275
- EMDR Assessment & Treatment $275
- Immigration Assessment & Report $1600 ($800 startup and $800 after completion) (601 waiver, hardship, substance abuse, domestic violence, sexual assault, criminal offense)
Document PreparationBasic Verification Letters & All other Report Writing $30 & up (Based on Complexity)FMLA Forms $75 (each set) Emotional Support Animal/ESA Letter $125 Medical Records $1.00 for each page of the first 25 pages and $0.50 for each additional page after Electronic Format: $25 for 50 pages or less and $50 for more than 50 pages.
Court Services Preparation time $250/hr. (calls depositions, testimony) Mileage $0.40/mile The minimum charge for a court appearance is $1500. A retainer of $1500 is due in advance. If subpoena or notice received without 48-hr notice, there is a $250 express fee. If the case is reset with less than 48 notice $500 fee.
Important Payment Information
Payment Options: We take health insurance, HSA, FSA, cash, checks, credit cards, and Cash App ($darbarmsw). Payment is collected immediately prior to or following your appointment. Autopay is available upon request. Visit www.baroncounseling.com for more alternatives.
Balance Due: Payment is due by the time of the service. We do not expect to have a balance. However, if this does occur, we will wait until your balance has been paid before scheduling another appointment.
Cancellation policy: Please call us within 24 hours to cancel an appointment. A $125.00 fee will apply to all missed appointments not canceled within 24 hours. After three “NO SHOW” and excessive late or last-minute canceled appointments, you will be discharged from our practice, and we will no longer see you as a patient. A full session fee is charged for missed appointments or cancellations with less than 24-hour notice unless it is due to illness or an emergency. A bill will be issued directly to all clients who do not show up for or cancel an appointment.
Insurance Reimbursements: While we are working on getting on most insurance panels, it is your responsibility to seek reimbursement for fees. We will provide you with a receipt after each session.
Returned Check policy: We will charge you a $35.00 returned fee plus the amount of the service fee owed. Declined or Charge Back Credit Card Policy: We will charge you an online payment cost of 3.15% + $0.30 for each declined transaction, plus the service fee owed.
Additional health care provider/facility notes: When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
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, and does not include any unknown or unexpected costs that may arise during treatment.If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
Throughout your treatment, the provider may recommend additional items or services as part of your treatment that are not reflected in this estimate. These would need to be scheduled separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate.
If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes.
You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
The Good Faith Estimate is not a contract between provider and client and does not obligate or require the client to obtain any of the listed services from the provider.