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  • Good Faith Estimate & No Surprises Act

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    In order to make the process of beginning counseling as easy and accessible as possible, Good Faith Estimates are provided to clients upon the start of services and annually with the new year thereafter.  

    Per the “No Surprises Act,” patients who self-pay have the right to receive a good faith estimate of costs for services being provided. The goal of this act is to reduce the likelihood that patients may receive a surprise medical bill from healthcare providers, and so healthcare providers must inform patients of an expected charge for a service before the service is provided. This good faith estimate will include services provided, frequency, cost, and, if applicable, a diagnosis code.

    Amy Moulton Counseling, LLC does not accept insurance payments and is not in network with any insurance providers at this time. As such, all patients will need to have a valid credit card on file at all times and payment is due at the time of service. You may also pay using HSA card or cash, but please inform counselor at the time of your appointment.

    If you have an insurance plan that offers Out-of-Network benefits, you have the right to request a superbill (or statement of payment for out of network services). You may submit a claim for reimbursement of services to your insurer. This in no way acts as a guarantee by Amy Moulton Counseling of reimbursement to patients from insurance. It is the responsibility of patients to confirm any such benefits with their insurance provider based on an individual’s plan.

    Common Service and Services Codes used by Amy Moulton Counseling, LLC

    • 90791: Therapy intake
    • 90834: 45 minute counseling session
    • 90837: 60 minute counseling session 
    • 90837: 60 minute counseling (EMDR)

    At Amy Moulton Counseling, LLC, we recognize that everyone has their own individual timeline and journey in therapy. How long you may want or need to engage in counseling can be influenced by a number of factors. Parts of life such as your schedule and life circumstances, the availability of the counselor, ongoing challenges in your own life, and the nature of the work you bring to counseling may impact duration and frequency of sessions.

    The patient and therapist will continually assess for the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready to discontinue with sessions.

    The current full rate for counseling and psychotherapy services at Amy Moulton Counseling, LLC are as follows:

    • Therapy Intake: $175/session
    • 45 – 60 minutes (Counseling/Psychotherapy for an Individual): $175/session

    This rate does not vary or increase with experiential therapies or specialized modalities such as EMDR or IFS.

    In some cases, there are circumstances where a reduced fee arrangement may be necessary for a time. This is determined on a case by case basis between the counselor and the patient, with consideration of financial circumstances and availability.

    Amy Moulton Counseling, LLC reserves the right to review its fee structures annually.

    Common Questions

    Is the Good Faith Estimate a bill?

    No, absolutely not. The estimate you receive is just that, an estimate of what costs would be for one year, based on the frequency of sessions that you and I have discussed and agreed upon.

    Am I “locked in” to the number of sessions that are listed?

    Of course not! Often, despite our best efforts, real life gets in the way. We catch a cold, or kids have events we need to attend, cars are in the shop, or we simply forget we scheduled a session for that day. If you schedule or hold less sessions than are listed on your good faith estimate, you are only billed for completed sessions where services are provided.

    You’re also not limited to the number of sessions that are listed on the estimate. If you and I discuss and decide that sessions with greater frequency may be required for a time, the estimate does not prevent additional sessions being scheduled.

    What do I do if I am charged for more than is listed on the Good Faith Estimate?

    Per the state, you may start with contacting your counselor to let them know the billed charges are higher than the Good Faith Estimate. Your healthcare provider may update the estimate, you may ask to negotiate the bill, or ask about financial assistance opportunities that may be available to you.

    You also have the right to start a dispute 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 within 120 calendar days (so, roughly 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing the dispute agrees with you, you will have to pay the price of the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you will have to pay the higher amount.

    To learn more and get a form to start the process, go to or call 1-800-985-3059.

    For questions or more information about your right to a Good Faith Estimate or the dispute process, visit or call 1-800-985-3059.