Contact Melissa Groman
Melissa Groman, LCSW and Therapy Associates
Good Faith Estimate
For clients who are not seeking out of network insurance reimbursement (in network not accepted), a written detailed good faith estimate will be provided at the first session with the fee once the fee has been mutually agreed upon.
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform 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 of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.
Note: The PHSA and the GFE does not apply currently to any clients who are using insurance benefits, including Out of Network Benefits (seeking reimbursement from your insurance companies).
Estimated Costs of Services
Sessions can be weekly, twice weekly, bi-weekly, monthly -or as determined by you and/or in consultation with your therapist. Sessions may continue as long as determined by you and/or in consultation with your therapist. There is no fee for discontinuing sessions at any time and you will only be charged for sessions you attended or failed to cancel according to the late cancel policy of cancelling within 24 hours of a scheduled session. The total cost per year will vary and depends on total number of annual sessions at the session fee. As there is no exact way of providing a total annual estimation due to vacations, holidays, cancellations/ sickness, or longevity of treatment, and frequency variables, estimated annual cost will be based on how many sessions per year x the below rate.
For current session fees please contact Melissa Groman
Common Services for Psychotherapy
90834: 45-52 minute psychotherapy session
90837: 52-60 minute psychotherapy session
90847: Family/Couples psychotherapy session
*90839: Outside of session consultation
Services may be provided:
In person in our NJ Offices
*Please note that the occasional brief phone call (under 15 minutes) is included in service for regular clients. However, the provider may feel that the issue warrants a session, in that case the provider must verbalize that this is considered a session prior to billing for service. Any phone calls between therapist and client or on client’s behalf with consent and request will be billed at session fee prorated after 15 minutes.
Provider Name: Melissa Groman, LCSW and Therapy Associates
DISCLAIMERS & YOUR RIGHTS
The information provided in this good faith estimate is only an estimate and that actual items, services, or charges may differ from the good faith estimate.
You as a patient have the right to initiate a patient-provider dispute resolution process if the actual billed charges substantially exceed the expected charges included in the good faith estimate.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
The good faith estimate is not a contract and does not require any individual to obtain the items or services from any of the providers or facilities identified in the good faith estimate.
If you receive a bill that is at least $400 more than your Good Faith
Estimate, you can dispute the bill. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.
Additional note regarding mental health care services: Your frequency and number of sessions is entirely up to you.
By signing below, I understand that my provider is providing a "good faith estimate” of the cost associated with my care.