Good Faith Estimate (for self-pay clients)

As part of our commitment to transparency and in compliance with federal law under the No Surprises Act, we are providing you with a Good Faith Estimate (GFE) of the expected charges for the psychiatric services you will receive over the next year if you are paying for our services directly. This estimate is based on the information available at this time and is intended to help you understand your potential financial responsibility.

Good Faith Estimate Details

Below is an estimate of the costs for your psychiatric care with Ascend Psychiatric Services for the first 12 months of care.

Service Description                Frequency             Estimated Cost per Session                     Total Estimated Cost
Psychiatric Evaluation             1 session                             $210                                                           $210
Medication Management       9 sessions                           $100                                                           $900
No-Show Fee                           As applicable                     $100                                               Not included in total

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Total Estimated Cost for One Year: $1,110 (Ave $92/month)

 

Additional Services
Additional services that may incur fees include, but are not limited to:

• Extended Visits: Additional fees may apply for visits that extend beyond the
allotted time.

• Service Animal Assessments: Fees for assessments related to service animals.

• Paperwork Completion: Fees for extended time required to complete requested
paperwork.

• Genetic Testing: Additional fees may apply for genetic testing, if requested.

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Cancellation Policy

We require 48 hours’ notice to cancel an appointment. This allows us to offer your time slot to another patient who may need an appointment. If you cancel your appointment in less than 48 hours or miss your appointment, a missed appointment fee of $100 will be charged. This fee will be charged to the credit card on file.

Important Notes

• This is an Estimate Only: The actual services you receive may differ based on your clinical needs, and the total cost may vary.

• Self-Pay Practice: Payment is due at the time of service, and you are responsible for all charges. 

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Your Rights
Under the No Surprises Act, you have the right to receive a Good Faith Estimate for the total expected cost of your care. If you are billed for an amount significantly higher than this estimate, you may dispute the bill. For more information about your rights, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Next Steps
If you have any questions about this estimate or your treatment plan, please don’t hesitate to contact us at admin@ascendpsychiatricservices.com. We are here to support you and ensure you have a clear understanding of your care and associated costs.

Thank you for trusting us with your psychiatric care. We look forward to working with you to support your mental health and well-being.