Good Faith Estimate
Your Right to Understand Therapy Costs
Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for mental health services. We're committed to transparent pricing so you can make informed decisions about your care.
Effective January 1, 2022
Understanding Your Good Faith Estimate
What This Document Means
The Good Faith Estimate provides expected costs for therapy services at KMH Counseling. This helps you:
- •Understand potential expenses
- •Plan your mental health investment
- •Avoid surprise bills
- •Make informed decisions
This is an estimate, not a contract for services
Service Codes & Costs
Initial Diagnostic Evaluation
Individual Psychotherapy (Standard)
Individual Psychotherapy (Extended)
EMDR Therapy Session
Typical Treatment Scenarios
Short-Term Therapy
sessions
Moderate-Term Therapy
sessions
Long-Term Therapy
sessions
These are estimates only. Your actual needs may vary.
If You Have Insurance Coverage
In-Network Insurance
(BCBS PPO, Aetna, Cigna)
Your cost will typically be:
- •Copay: $20-40 per session
- •Or coinsurance: 10-20% of allowed amount
- •After deductible is met
Out-of-Network Insurance
Your cost will typically be:
- •Full fee paid upfront: $185-250
- •Reimbursement: 50-80% of fee
- •After out-of-network deductible
Contact your insurance for specific coverage details
What May Change Your Estimate
Treatment Duration
- •Severity of symptoms
- •Treatment goals
- •Progress rate
- •Life circumstances
- •Personal preference
Session Frequency
- •Weekly vs. biweekly
- •Maintenance sessions
- •Crisis periods
- •Schedule flexibility
Service Type
- •Standard therapy
- •EMDR processing
- •Extended sessions
- •Crisis intervention
Understanding Financial Expectations
Payment Due
- •At time of service
- •Before session begins
Accepted Payment:
- • Credit/debit cards
- • HSA/FSA cards
- • Cash or check
Cancellation Policy
- •24-hour notice required
- •No charge with proper notice
- •Full fee for no-shows
Your Rights & Protections
Under the No Surprises Act
You Have the Right To:
- •Receive this estimate before services
- •Be notified of changes exceeding $400
- •Dispute bills that exceed estimate
- •Choose different providers
- •Ask questions about costs
If Your Bill Exceeds Estimate by $400+:
- •You can dispute the charges
- •Contact: 1-800-985-3059
- •Visit: cms.gov/nosurprises
Questions About Costs?
We're here to help you understand your investment in mental health care.
Common Questions:
"What if I need more sessions than estimated?"
We'll discuss ongoing costs and adjust the estimate as your treatment progresses.
"Can I reduce costs?"
Options include: using insurance, HSA/FSA.
Contact Information:
KMH Counseling
1820 W. Webster Ave, Suite 400
Chicago, IL 60614
📞 (312) 869-2081
✉️ katherine@kmhcounseling.com
This estimate does not obligate you to continue treatment