Good Faith Estimate (GFE)

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give 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 for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.

This estimate is based on a year of treatment (52 weeks), at our regular rates. Your total may be less based on a negotiated rate and frequency with your clinician.

Common service codes provided by Amanda D. Jones, LCSW:

  • 90837: Psychotherapy, 60 minutes

  • 90847: Family or couples psychotherapy, with the patient present.

Common diagnostic codes used by Amanda D. Jones, LCSW:

F32.1 Major depressive disorder, single episode, moderate

F32.9 Major depressive disorder, single episode, unspecified

F33.0 Major depressive disorder, recurrent, mild

F33.1 Major depressive disorder, recurrent, moderate

F33.2 Major depressive disorder, recurrent, without psychotic features

F41.1 Generalized anxiety disorder

F41.9 Anxiety disorder, unspecified

F43.10 Post traumatic stress disorder (PTSD), unspecified

F43.12 Post traumatic stress disorder (PTSD), chronic

F43.20 Adjustment disorder, unspecified

F43.21 Adjustment disorder with depressed mood

F43.22 Adjustment disorder with anxiety

F43.23 Adjustment disorder with mixed anxiety and depressive mood

F90.0 Attention-deficit disorder (ADHD), predominantly inattentive type

90.2 Attention-deficit hyperactivity disorder (ADHD), combined type

F90.9 Attention deficit hyperactivity disorder (ADHD), unspecified type

Where services will be rendered:
102 B Madison Ave, Asheville, NC 28801
Online through agreed upon virtual format

Length of time in treatment: Your clinician recognizes that every client comes into treatment with different needs and life circumstances. Each client’s journey to healing is unique. The length of time in treatment is determined by many different factors, including: your schedule and life circumstances, therapist availability, ongoing life challenges, the nature of your specific challenges and how you address them. You and your therapist will continually assess the appropriate frequency and duration of therapy, and will work together to determine when you have met your goals and are ready for discharge.

On average, individual and couples therapy spans 3–6 months, typically starting with weekly sessions and transitioning to biweekly as progress is achieved.

The current Good Faith Estimates are based on full fee rates for weekly psychotherapy services:

60 minutes (Individual Psychotherapy): $160/session

3 months (12 sessions)   GFE: $1920  

6 months (24 sessions) GFE: $3840

9 months (36 sessions) GFE: $5760

12 months (48 sessions) GFE: $7680


60 minutes (Couples/Family Psychotherapy): $200/session   

3 months (12 sessions) GFE: $2400 

6 months (24 sessions) GFE: $4800

9 months (36 sessions) GFE: $7200  

12 months (48 sessions) GFE: $9600

Disclaimer
The Good Faith Estimate shows the cost of 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 the course of treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) services that are more than $400 above the estimated cost of services.

The Good Faith Estimate is not a contract and therefore does not require you to obtain the items or services provided by Amanda D. Jones, LCSW. At the foundation of a good therapeutic relationship between client and therapist is the client’s right to self determination and autonomy. Therefore you (as the client) have the right to terminate services at any time.

If you are billed for more than this Good Faith Estimate, you have a right to dispute the bill.
You may contact your clinician 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 as 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 pay the price of the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you must pay the higher amount.