The Relationship Institute of New Jersey can offer requesting self-pay clients (current or future) a “good faith estimate” of the expected total charges for psychotherapy services. Please continue to read for an explanation.
Providing a good faith estimate upon request to self-pay clients who are not using/planning to use health insurance to cover psychotherapy costs is required under the No Surprises Act that went into effect 1/2022 (as written into Section 2799B-6 of the Public Health Service Act). Good faith estimates don’t apply to clients using health insurance benefits to pay for these costs.
For the purposes of the Relationship Institute of New Jersey, a good faith estimate of the costs of psychotherapy services for a particular client is calculated by estimating the agreed-upon cost of individual psychotherapy sessions at a specific frequency (e.g., 1x a week), over a specific time period (e.g., 52 weeks/12 months).
Services Offered by Patrick R. Connelly, LCSW (NPI: 1417016908 Tax ID: 54-1903970)
| Service Description | CPT Code | Frequency | Fee Per Session |
| Initial Intake – 60 minutes | 90791 | One Time | Up to $240 |
| Individual Psychotherapy – 60 minutes | 90837 | 1-4 times/month | Up to $240 |
| Individual Psychotherapy – 45 minutes | 90834 | 1-4 times/month | Up to $180 |
| Couples Psychotherapy- 50-60 minutes | 90847 | 1-4 times/month | Up to $240 |
| Additional Session Time as Needed | N/A | As Needed | $120/30 minutes |
Estimated Yearly Charges
(Actual charges may vary according to the frequency of services and amount of time spent in each service. Also note that other costs may arise, for example, no-show/late cancellation charges of up to the full agreed upon fee per session.)
| Services | Frequency | Total # Sessions | Fee/Session | Total Yearly Cost |
| Initial Intake plus Individual/Couples Psychotherapy | Once per week | 52 | $240 | $12,480 |
| Initial Intake plus Individual/Couples Psychotherapy | Every other week | 26 | $240 | $6,240 |
Keep in mind, however, that it is simply not possible for a therapist to know, in advance, how many counseling sessions may be necessary, appropriate, manageable or even desirable for a given person or couple. Actual frequency and duration of psychotherapy services will depend at least in part on factors such as the severity of symptoms presented, the client’s circumstances, and complexity of treatment needed. There may be additional services/items that the therapist and client together agree upon over the course of psychotherapy that are not reflected in an initial good faith estimate. It is important to note that a good faith estimate is not a contract binding either the provider or the client.
Should a client question that the actual billed charges substantially exceed the expected charges set forth in a good faith estimate, this matter can be discussed directly with the provider. The initiation of client dispute resolution process will not adversely affect the quality of health care services provided to the client. The therapist can provide receipt of services with details on type of service, duration and CPT code as applicable, upon request, at/after each visit.
