Good Faith Estimate

Kate Winderman, Ph.D., L.P., PLLC

Texas State License: 38258
Minnesota State License: LP 7331
NPI: 1538703996
www.drkatewinderman.com
drkate@drkatewinderman.com

Good Faith Estimate

Disclaimer

You are entitled to receive this Good Faith Estimate of what the charges could be for engaging in psychotherapy services with Dr. Winderman. While it is not possible to know in advance how many sessions may be necessary or appropriate, this form provides an estimate of the cost of services you may receive. Your total cost of services will depend on the type and number of psychotherapy services you attend. Please note that at the end of each session, you and Dr. Winderman will discuss your next scheduled session, and will only consent to only one session at a time. This estimate is not a contract, and does not obligate you to attend services with Dr. Winderman. It does not include any services not identified here. Additional services such as letters, reports, or coordination with other providers may incur additional charges as discussed in your consent paperwork.

This estimate does not predict or recommend that you will need a specific number of sessions. The frequency and duration of treatment depend on your needs and goals, and may change over time. You may choose to end treatment at any time. While some clients benefit from short-term work (e.g., 8–12 sessions), others may engage in therapy for several months or longer.

Estimated Charges

Dr. Winderman’s fee structure is as follows:

  • 50 Minute Intake Session for Individuals (CPT Code 90791): $240

  • 80 Minute Intake Session for Couples (CPT Code 90791): $395

  • 50 Minute Individual Therapy Session (CPT Code 90834): $220

  • 80 Minute Individual Therapy Session (CPT Code 90834): $355

  • 50 Minute Couples Therapy Session (CPT Code 90847): $240

  • 80 Minute Couples Therapy Session (CPT Code 90847): $375

Most clients attend one session per week; however, you and your therapist will determine the frequency that best fits your needs.

Range of costs for Individual Therapy

Based on a fee of $220 per visit, including the intake session at $240, the following are examples of expected charges of psychotherapy services:

  • 1 Intake and 1 Week of Service: $460

  • 1 Intake and 13 Weeks of Service: $3100

  • 1 Intake and 26 Weeks of Service: $5960

  • 1 Intake and 39 Weeks of Service: $8820

  • 1 Intake and 52 Weeks of Service: $11680

Range of costs for 80 Minute Couples Therapy

  • Based on a fee of $375 per visit, including the intake session at $395, the following are examples of expected charges of couples psychotherapy services:

    • 1 Intake and 1 Week of Service: $770

    • 1 Intake and 13 Weeks of Service: $5270

    • 1 Intake and 26 Weeks of Service: $10145

    • 1 Intake and 39 Weeks of Service: $15020

    • 1 Intake and 52 Weeks of Service: $19895

Please note that the examples listed above for both individual and couples therapy expected charges could also change based on whether you select 50 minute or 80 minute sessions.

Your Rights

If you are billed for $400 more than this Good Faith Estimate, you have the right to dispute the bill. You may request that the bill be reviewed, that it be adjusted to match this estimate, or that you receive financial assistance or payment arrangements. You may also use the dispute resolution process with the US Department of Health and Human Services. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this GFE. If the agency disagrees with you and agrees with the health care provider, you will hae to pay the higher amount. For more information, visit www.cms.gov/nosurprises

By signing below, you confirm that you have received this Good Faith Estimate and understand that actual charges may vary depending on your treatment needs.