NO SURPRISES ACT - 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. It is used by health care providers to inform individuals who are not enrolled in a plan or coverage or a Federal health care program (uninsured individuals), or individuals who are enrolled but not seeking to file a claim with their plan or coverage (self-pay individuals) of the expected charges they may be billed for receiving certain health care items and services. In summary:​​

  • You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services.
  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
  • You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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.

NO SHOW/LATE CANCELLATION FEES

Late cancellations and re-scheduled session will be subject to a $165 fee, that will be charged to your card on file, if cancellation or reschedule request is NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. 
Should you No-Show to your session, reschedule and/or cancel on SAME DAY of your session, the full session fee of $165 will be charged to your card on file. If using insurance, YOU WILL BE RESPONSIBLE for the FULL PRACTICE RATE for session, NOT YOUR INSURANCE.
In the event of a late payment or declined transaction, a fee of $35 will be charged. To avoid any additional stress and ensure a seamless payment process, we kindly request prompt payment and offer various secure and convenient payment options, excluding checks.

DOCUMENTS, COURT APPEARANCES, ORDERS AND/OR SUBPOENA

Please note we do not offer services with the intention of being used as an expert witness or testification purposes on your behalf. We do not offer court appearances.
IF a court appearance is required per subpoena or court order, there is a non-refundable cost of $750 per hour for travel time and court preparation. A minimum of four hours of payment, $3000, is due prior to court appearance and is nonrefundable.
The rate may change if court is required in the future, after services with Nancy Crespo-Richardson LLC/Nancy Crespo- Richardson, LPC have ended.
Each page that needs to be photo copied, scanned or faxed will cost $5 per side. Any report that is required by court will be calculated based off $750 per hour.

ADDITIONAL DOCUMENTS/LETTERS

School letters/Mental Health Disability Assessment Form – $50
Verification of Services Letter – $5
Treatment Progress/Review Report – $50
Immigration Evaluations – start at $1000 per person (higher fees based if more than 4 sessions needed for gathering of information. Additional fee for expedited reports of 2 weeks)
Payment is due prior completion of service.
***We do not complete FMLA or disability claims forms, nor do we write Emotional Support Animal letters*** 

CONSULTATIONS

Should you request for me to speak with your lawyer, primary care provider, prescribing provider, school representative the following fees apply:
Telephone/Video Chat formats – $25 per 15 minutes, rounded to the nearest 15 min mark.
In person conference/meeting – $165 per hour plus, $100 per hour of travel.