Forms & Fees

Fees

Transparency and honesty are foundational keys to building genuine, connected relationships. With that in mind, our current fee schedule for counseling/therapy and medication management services are listed here. Please note that fee structures do change from time to time.

If you are utilizing your insurance plan to cover all or part of your fees, please remember:

1. Insurance companies base coverage on medical necessity, we are legally required to submit diagnosis and, in certain circumstances, progress notes, for services to be covered.
2. You may be responsible for a deductible, co-pay or co-insurance cost as assigned by your plan

We strongly encourage our clients to contact their insurance company for the most accurate, detailed information about your coverage.

If you are paying out-of-pocket, you are legally entitled to a good faith estimate for the fees incurred for services.  

Good Faith Estimate

Starting January 1, 2022, under Section 2799B-6 of the Public Health Service Act also known as the “No Surprises Act”, 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 programme, 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.  The purpose of this law is to protect self-pay/uninsured consumers from unanticipated and expensive bills for out-of-network services. 

Under the law, health care providers are required to provide patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate explaining how much your treatment will cost
• You have the right to receive the Good Faith Estimate at least 1 business day BEFORE your first scheduled appointment
• You have the right to dispute the bill if your costs are at least $400 more than your Good Faith Estimate
• Be sure to save a copy or picture of your Good Faith Estimate for future reference

For additional questions or for more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 847-440-2281 to discuss with our Billing Department.

The No Surprises Act applies specifically to those individuals who do not have insurance or who do not intend to use their insurance.  If Collaborative Counseling & Psychiatry will bill your insurance or you plan to submit to insurance on your own, the right to receive a Good Faith Estimate does not apply to you.  If you are using insurance, whether in-network or out-of-network, it is our policy to verify your benefits prior to your first appointment with us.  The No Surprises Act and Good Faith Estimate adds to this existing policy by requiring formal disclosures of anticipated fees specifically for self-pay and uninsured peoples.