Faith estimate for health care items & services for Modern Intervention Strategies.

Compliance with No Surprises Act:

• In accordance with the federal No Surprises Act (effective January 1, 2022), we provide uninsured and self-pay clients with a good faith estimate of costs for our services. This estimate is designed to help you anticipate potential costs and avoid surprise bills.

The current full rates for individual counseling, couples, and families  and psychotherapy services with a licensed provider (e.g. LPC, LCSW, LMFT, MA, MS) at Modern Intervention Strategies, LLC are listed below and outlined in the Practice Fee Schedule.

Standard Fees:

• Individual Therapy: $175 per 50-minute session.
• Couples Therapy: $205 per 50-minute session.
• Family Therapy: $250 per 50-minute session.

Out-of-Pocket Package Deals:

• Individual Therapy Packages:
  • Silver: 5 sessions for $750 
  • Gold: 10 sessions for $1,500
  • Platinum: 15 sessions for $2,250 
  • Price per session $175
• Couples Therapy Packages:
  • Silver: 5 sessions for $875
  • Gold: 10 sessions for $1,750
  • Platinum: 15 sessions for $2,625
  • Price per session $205
• Family Therapy Packages:
  • Silver: 5 sessions for $1,150 
  • Gold: 10 sessions for $2,250 
  • Platinum: 15 sessions for $3,325 
  • Price per session $250

Additional Information:

• Cancellation/No-Shows: Clients are responsible for the full session fee for missed appointments or would forfeit one of the sessions from the package.
• Duration of Therapy: You and your therapist will regularly check in regarding your progress to assess the appropriate frequency of your sessions, and to determine when you have met your goals and are ready to end therapy.

It is your right to determine your goals for treatment and how long you would like to remain in therapy unless you are pursuing mandatory treatment. You and your therapist will continually check in regarding your progress, to assess the appropriate frequency of your sessions, and to determine when you have met your goals and are ready to end therapy. The fees outlined are provided to support you in discussing with your therapist what you may owe if you agree to receive care at Modern Intervention Strategies, LLC. The total cost of services may be influenced by many factors:

• Your schedule and life circumstances
• Therapist availability
• Ongoing life challenges
• The nature of your specific presenting concerns/diagnosis (if applicable) and how you address them

Modern Intervention Strategies, LLC is currently in-network with most insurance plans. Modern Intervention Strategies, LLC, however, does not have an agreement with all insurance plans. Clients enrolled in an insurance plan that Modern Intervention Strategies does not accept, and consent to receive services here acknowledge that they will be responsible for the full cost billed for any items or services received and understand that receiving services here may cost them more. Clients are encouraged to contact their health plan for support in finding an in-network provider or if they intend to request reimbursement for out-of-network services or apply their payments toward their out-of-pocket limit; an insurer may agree to negotiate an arrangement with an out-of-network provider if there are no in-network providers available. You should not consent to receive services at Modern Intervention Strategies, LLC if you did not choose where to receive care. By consenting to receive services at Modern Intervention Strategies, LLC, you understand that:

• You are giving up your protections under the law.
• You may owe the total costs billed for items and services received.
• Your health insurance plan might not count any of the amounts you pay towards your deductible and out-of-pocket limit and may not reimburse you fully or at all for any out-of-pocket payments you make. Contact your health plan for more information.

DISCLAIMER

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs. The actual charges may differ; this estimate is not an offer or contract of services. You could be charged more if complications or special circumstances occur. Federal law allows you to dispute the bill if you are billed more than this Good Faith Estimate.

Dispute Resolution Process:

If billed more than the estimate, you have the right to dispute the bill. You may contact Modern Intervention Strategies, LLC or initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS). To start the dispute process, visit www.cms.gov/nosurprises or call HHS at (800) 368-1019.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.

Modern Intervention Strategies, LLC

EIN: 84-3267788