Good Faith Estimate
Flourish Counseling and Wellness, PLLC
537 College Street
Suite #102
Asheville, NC 28801
GOOD FAITH ESTIMATE
Effective January 1, 2022, a ruling went into effect called the "No Surprises Act" which requires
practitioners to provider a "Good Faith Estimate" of the costs you may incur as a result of
utilizing out-of-network medical care. The Good Faith Estimate works to show the cost of items
and services that are reasonably expected for your health care needs for an item or service, a
diagnosis, and a reason for therapy. The estimate is based on information known at the time the
estimate was created. The Good Faith Estimate does not include any unknown or unexpected
costs that may arise during treatment. You could be charged more if complications or special
circumstances occur and will be provided a new "Good Faith Estimate" should this occur. If this
happens, federal law allows you to dispute (appeal) the bill if you and your therapist have not
previously talked about the change and you have not been given an updated good faith
estimate.
Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and
health care facilities are required to inform individuals who are not enrolled in a plan or coverage
or a Federal health care program, or not seeking to file a claim with their plan or coverage both
orally and in writing of their ability, upon request, or at the time of scheduling health care items
and services to receive a "Good Faith Estimate" of expected charges.
Timeline requirements: Practitioners are required to provide a good faith estimate of expected
charges for a scheduled or requested service, including items or services that are reasonably
expected to be provided in conjunction with such scheduled or requested item or service. That
estimate must be provided within specified timeframes: If the service is scheduled at least three
business days before the appointment date, no later than one business day after the date of
scheduling; If the service is scheduled at least 10 business days before the appointment date,
no later than three business days after the date of scheduling; or If the uninsured or self-pay
patient requests a good faith estimate (without scheduling the service), no later than three
business days after the date of the request. A new good faith estimate must be provided, within
the specified timeframes if the patient reschedules the requested item or service.
Common Services at Flourish Counseling and Wellness, PLLC, with our "full fee" per session:
90791: Initial therapy intake session = $200
90837: Ongoing therapy appointments (53-60 minutes) = $200
90834: Ongoing therapy appointments (37-53 minutes) = $140
90832: Ongoing therapy appointments (16-36 minutes) = $125
90847: Family appointments (approx 30-55 minutes) = $200
90846: Family appointments without client present: (approx 30 minutes) = $125
Please note that we do not provide couples / marriage counseling as a "medically necessary"
service for mental health treatment and couples / marriage counseling is therefore not covered
by the No Surprised Act, unless one party meets medical necessity for a mental health diagnosis that is actively being treated as part of their services. The fee for initial and ongoing couples / marriage counseling sessions is $250.
Additional separate charges will occur in the event that your therapist is involved in services
that are not directly providing mental health treatment as outlined above, such as involvement in
court proceedings or letter writing on your behalf. These additional non-medical fees are outlined in our consent for services.
Some of the common diagnosis codes treated at Flourish Counseling and Wellness, PLLC are:
F43.20 - Adjustment Disorder, Unspecified
F90.2 - Attention-deficit/hyperactivity disorder, Combined presentation
F84.0 - Autism spectrum disorder
F31.81 - Bipolar II disorder
F41.1 - Generalized anxiety disorder
F33.9 - Major depressive disorder, Recurrent episode, Unspecified
F41.0 - Panic disorder
F43.10 - Posttraumatic stress disorder
F94.0 - Selective mutism
F93.0 - Separation anxiety disorder
F40.10 - Social anxiety disorder
F40.248 - Specific phobia, Other
F43.89- Unspecified trauma- and stressor-related disorder
Please know that this list is not exhaustive and that your diagnosis may not be shown on the list
above and may change over time based on many factors. Please speak to your therapist with
any questions or concerns you have related to your diagnosis and we can provide you with
additional information and/or documentation upon request.
Duration and frequency of services:
As therapists, we recognize that every client's therapy journey is unique and it is therefore
difficult to accurately "predict" how many sessions you will attend and how long you will be
engaged in mental health treatment with Flourish Counseling and Wellness, PLLC.
Many people attend therapy sessions once weekly, while others choose to attend more or less
frequently. Some individuals engage in services for a very short period of time while others
remain in treatment for extended periods of time, and still others will "start and stop" services
over a period of time in response to changes in symptoms and/or life circumstances.
The duration and frequency of your engagement in mental health treatment may vary and will
likely be influenced by many factors including, but not limited to:
* Your schedule and life circumstances
* Therapist availability
* Ongoing life challenges
* The nature of your specific mental health condition
* Your level of engagement in sessions and in completing homework
* Personal finances
* Your own personal desire to continue or discontinue treatment
You and your therapist will continually assess the appropriate frequency of therapy and will work
together to determine when you have met your goals and are ready for discharge and/or a new
"Good Faith Estimate" can be requested at any time.
If you were to attend standard 55-minute therapy sessions once weekly for 52 weeks at our full fee of $200 per session, your estimated annual cost for services at Flourish Counseling and Wellness would be $10,400.00.
In the event that you attended an additional 12 standard 55- minute therapy sessions per year, your estimated annual cost for services would be $12,800.00.
If you were to attend couples or marriage counseling sessions once weekly for a year at a rate of $250 per session, your estimated annual cost for services would be $13,000.
Provider information:
Flourish Counseling and Wellness, PLLC has a physical location and also offers telehealth sessions therapy via a HIPAA secure telehealth platform.
Our physical locations is:
537 College Street
Suite #102
Asheville, NC 28801
Our practice owner is Jill Williams, LCSW / NPI #1285942391
Our TIN is 81-3266191
Our Type 2 NPI is #1245804590
We have multiple mental health providers employed through Flourish and an updated provider list is available at any time by contacting the Flourish office at 828-532-6717 or emailing jill@flourishasheville.com
Please note that the above listed information does not constitute a contract that requires you to
obtain the above detailed services through Flourish Counseling and Wellness, PLLC, and
likewise does not require the therapists at Flourish to provide the detailed services listed above.
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. The Good Faith Estimate does
not include any unknown or unexpected costs that may arise during treatment. You
could be charged more if complications or special circumstances occur. If this happens,
federal law allows you to dispute (appeal) the bill. If you are billed for more than this
Good Faith Estimate, you have the right to dispute the bill. 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.
You may also start a dispute resolution process with the U.S. Department of Health and
Human Services (HHS). If you choose to use the dispute resolution process, you must
start the dispute process within 120 calendar days (about 4 months) of the date on the
original bill. There is a $25 fee to use the dispute process. If the agency reviewing your
dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If
the agency disagrees with you and agrees with the health care provider or facility, you
will have to pay the higher amount.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it to ensure
that you have accurate information in the event that you are billed more than the
amount outlined on this Good Faith Estimate.