Good Faith Estimate for Separation/Divorce/Co-Parenting Counseling
Under the No Surprises Act, relationship counseling clients who do not have insurance or who are not using insurance have the right to receive an estimate of the expected charges for services.
Current Fee Schedule
The following is a detailed list of expected charges for Separation/Divorce/Co-Parenting Counseling services at New Chapter Relationship Counseling. These rates are valid for 12 months from the date your personalized Good Faith Estimate is issued:
- All Separation, Divorce, and Co-Parenting Counseling sessions are billed at a flat rate of $300.00 per hour, determined by the length of the session reserved on the calendar.
Important Billing Policies for Co-Parenting and Separation Work
- Sessions Ending Early (Agenda Completed): If a scheduled session ends early because all agenda items have been successfully completed, you will only be billed for the actual time spent. This is calculated at the $300.00/hour rate, rounded up in 15-minute increments.
- Incomplete Sessions (Unwillingness to Engage/Leaving Early): To maintain a safe and productive environment, clients are expected to adhere to practice guidelines for respectful and cooperative engagement. If a session is terminated early due to a client's unwillingness to follow these expectations, or if a client leaves a session before the scheduled end time, the session will be billed at the full rate of the reserved time slot.
- No-Show Policy: Because co-parenting and separation counseling require the presence of both partners to proceed, if either partner fails to show up for a scheduled session, the session cannot occur and the full rate of the reserved time slot will be charged to the partner who failed to show.
- Late Cancellation Policy: Cancellations made with less than 48 hours' notice will be billed at half the rate of the reserved session.
Estimated Course and Duration of Services
Separation, divorce, and co-parenting counseling is highly individualized. The total number of sessions and the duration of your counseling (ranging from several weeks, to months, or longer) will be determined collaboratively based on your specific family needs, progress, and goals.
- Session Length: Session duration may range from 1 to 3 hours each, as decided together by the therapist and the couple prior to scheduling.
- Example of a 2-Hour Session Course (5 Sessions): 5 scheduled 2-hour sessions would total $3,000.00.
Terms and Disclosures
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your relationship counseling needs based on information known at the time the estimate was created.
Unexpected Costs: This estimate does not include any unknown or unexpected costs that may arise during our work together. You could be charged more if session times are extended or additional sessions are requested.
Right to Dispute: If you are billed for $400 or more over this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider 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.
Dispute Resolution Process: 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.
More Information: For questions, to learn more and get a form to start the process or to obtain more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.
Keep a copy of this Good Faith Estimate in a safe place or take a picture of it. You may need it if you are billed a higher amount.