Fees

30 minute sessions: 75.00

45 minute sessions: 115.00

60 minute sessions: 150.00 (200.00 for initial intake)

90 minute sessions: 225.00

Insurance

All clinicians take the following insurance unless otherwise specified:

Aetna

Anthem/Blue Cross Blue Shield

AultCare

Cigna: Mike Desposito & Sarah Fister only

Medical Mutual

Paramount: Katie Gamby & Dania King only

SummaCare

United Behavioral Health, United Healthcare, Optum

Good Faith Estimate

Background

Federal Legislation was passed in 2020 to protect patients form unexpected bills for healthcare services. The No Surprises Act (NSA) requires Good Faith Estimates (GFE) be provided for medical items or services. GFE disclosures took effect January 1, 2022 and the Health and Human Services (HHS) enforcement began in 2022. 

Provider Requirements

The Wellife, LLC therapists are required by the 2022 No Surprises Act to give you a Good Faith Estimate of the cost of treatment if you are uninsured or prefer not to use insurance for this care. 

Insurance

Until it is determined if you will use insurance or are self-pay, the information below is based on “fee for service” (out of pocket) rates. 

If you DO intend to use insurance, check with your insurance carrier to find out what your copayment or coinsurance rates will be. They are likely to be much lower. 

Assessment

Since your difficulties or symptoms have not yet been evaluated, the estimate for your course of treatment will be based upon the national average for a course of psychotherapy, which is 18 encounters. 

This initial estimate is valid for 12 months from the date of this document, but you are entitled to receive an update on this estimate at any time upon request.

Good Faith Estimate

Current ICD-10 diagnosis: R69 (diagnosis deferred).
Anticipated treatment: 

• 1 session of CPT 90791 (diagnostic evaluation) at [$200.00]

• 17 weekly sessions of CPT 90837 (psychotherapy, 60 minutes) at [$150.00] per session

• Total of estimated “fee for services” treatment without insurance: [$2,750.00]

This is just a rough estimate based on national averages. The duration of our work together can be longer or shorter depending upon your symptoms, your work between sessions, and your response to treatment. 

Unless required by a court order (an extremely rare situation), you are free to discontinue treatment at any time, and free to discuss any other modifications to treatment modalities, frequency, or duration. You are ultimately in control of your own healthcare; we are here to provide help at your request.

Location of treatment: All sessions will take place at [6663 Frank Ave. NW North Canton, OH 44720 or Online]