Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the “No Surprise Act” which requires practitioners to provide a “Good Faith Estimate” about out of network care. The Good Faith Estimate strives to show the cost of items and services that are reasonably expected for your health care needs based on your diagnosis, type of treatment, and your clinical needs. 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 may be charged more if complications or special circumstances occur and will be provided a new Good Faith Estimate. 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, health care providers and health care facilities are required to provide a good faith estimate of expected charges for items and services to 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, upon request or at the time of scheduling health care items and services.

Note: The PHSA and GFE does not apply currently to any clients who are using insurance benefits, including Out Of Network Benefits (seeking reimbursement from your insurance companies). 

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 items/services. This estimate much be provided within a specified timeframe:

  • If the service is scheduled at least 3 business days before the appointment date, no later than 1 business day after the date of scheduling.
  • If the services is scheduled at least 10 days before the appointment date, no later than 3 business days after the date of scheduling
  • If the uninsured or self-pay client requests a Good Faith Estimate (without scheduling the service), no later than 3 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 Associates In Psychotherapy

  • 90834 = Psychotherapy, 45 minutes with patient and/or family member
  • 90832 = Psychotherapy, 30 minutes with patient and/or family member
  • 90837 = Psychotherapy, 60 minutes with patient and/or family member
  • 90791 = Mental health diagnostic evaluation
  • 90847 = Family (or conjoint) psychotherapy with the patient present
  • 90846 = Family (or conjoint) psychotherapy without the patient present

Common Diagnosis Codes at Associates In Psychotherapy:

Please note these are common diagnosis codes at Associates In Psychotherapy but this list is not exhaustive. Diagnosis codes can change based on many factors. Please speak with your therapist with any questions or concerns.

  • Adjustment Disorder (F43.23)
  • Major Depressive Disorder (F32.9)
  • Generalized Anxiety Disorder (F41.1)
  • Bipolar Disorder (F31.9)
  • Schizoaffective Disorder (F25.9)
  • Attention Deficit Hyperactivity Disorder (F90.0)\
  • Obsessive Compulsive Disorder (F42.9)

Associates In Psychotherapy recognizes your journey in treatment is unique and will vary based on many variables including:

  • Your schedule and life circumstances
  • Therapist availability
  • Ongoing life circumstances
  • The nature of your diagnosis and how you respond to treatment
  • Personal finances

Associates in Psychotherapy will render all services in person or through a HIPAA Compliant virtual platform. We have 3 office locations:

  • 1740 North Ridge Avenue, Suite 101B, Evanston, Illinois 60201
  • 707 Lake Cook Road, Suite 105, Deerfield, Illinois 60015
  • 155 North Michigan Avenue, Suite 723, Chicago, Illinois 60601

Therapists at Associates In Psychotherapy:

  • Carolyn Bulmash, LCSW
  • NPI:1841212883 Rates: 90791- $170, 90837- $150, 90834- $135
  • Michelle Chaban, Psy.D.
    NPI:115438792 Rates: 90871- $200, 90837-$160, 90834- $130, 90832- $90, 90847/46- $160
  • Will Fisher, LCPC, M.Div
    NPI:1912434051 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Samantha Fox, Psy.D.
    NPI:1801338561 Rates: 90871- $200, 90837-$160, 90834- $130, 90832- $90, 90847/46- $160
  • Shama Joshi, LCSW
    NPI:1497023022 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Erin Lipin, LCSW
    NPI:1093014326 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Carey Rand, LCSW
    NPI:1396233433 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Megan Ray, LCPC
    NPI:1245795350 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Alicia Rogers, LCSW
    NPI:1487795960 Rates: 90791- $175, 90837-$140, 90834- $125, 90832- $75, 90846/47- $140
  • Cindy Templer, Psy.D.
    NPI:1376132142 Rates: 90871- $200, 90837-$160, 90834- $130, 90832- $90, 90847/46- $160
  • Allison Yambor, LCSW
    NPI:1427523091 Rates: 90791- $175, 90837-$150, 90834- $135, 90832- $90, 90847/46- $150