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Good Faith Estimate (GFE)

Good Faith Estimate

Rates and Fees for Services

D. Allen Novian, Ph.D. LMFT-S, LPC-S, BCN

It is important for clients to understand my fees and policies. Please ask if you have any questions—it is important to me that you are fully informed. I am not in network with any insurance companies. Upon request, I can provide a monthly invoice for you to submit to insurance for reimbursement, but please be aware that neurofeedback and qEEG services are not usually covered by insurance.

My services are private pay only, and the full fees are due on the date of service. You may pay by cash, check, or credit card. While clients are actively involved in therapy, I require a credit or debit card to be left on file in the ICFE secure, encrypted system to cover outstanding balances, including return check fees and no-show fees. I require at least 24-hour notice for any cancellations or rescheduled appointments; otherwise, the full fee for the scheduled session will be charged to the credit card you leave on file with ICFE. If you prefer to pay by cash or check, please let me know so we can indicate the payment preference in your file.

My rates for psychotherapy are as follows:

Initial Consultation (2 hours).................$300

qEEG Package (2 hour data collection, 90 min. review).....$750

Individual psychotherapy (50 minute session)…………………$185

Neurofeedback (Biofeedback by any modality) (50 minute session)……$185 pay per session

-10 session package: $1,665 (saves $185)

-20 session package: $3,145 (saves $555)

Most neurofeedback clients will need 20-40 sessions over 6-18 months.  Refunds for packages are at the therapist's discretion.

Couples therapy (50 minute session)……………………………$200

No Surprises Act

After our initial session, I will discuss with you the treatment options and potential treatment plan, including number of sessions, recommended to meet your therapy goals. In compliance with the No Surprises Act, I will provide a Good Faith Estimate (GFE) of costs if you request one, and the GFE will be updated in the event of a change in treatment plan or diagnosis. However, please be aware that fees per session only change based on the modality of services, not the diagnosis or treatment plan. Fees and cost for therapy are based on the time spent in therapy sessions. You may choose to stop therapy or transfer to a different therapist at any time. Therapy is voluntary and you as the client determine how many sessions you want to attend. Therapy clients should also be aware that many things outside the therapy session impact how quickly therapy goals are met and if the goals are met at all. The variables that impact the pace and effectiveness of psychotherapy include: clients’ follow through on ‘homework’ and changes suggested in therapy, health of the client’s support system, the severity and length of history of the problem being addressed, stressors unrelated to problem (such as employment, financial, extended family), clients’ physical health and illness, and many other factors. Psychotherapy, and especially relational therapy focused on couple or family issues, is unlike treatment for most medical conditions where, after accurate diagnosis, a concrete and time-specific intervention can be recommended. My goal is to be transparent with you throughout the therapeutic process to ensure you are fully informed and able to accurately anticipate costs for services.

*Litigation and Court Related Fees

I do not accept court-ordered and court-involved cases.  If I discover that you are involved with or seeking legal action related to therapy, I will transfer you to another therapist immediately. Serving as your therapist does not equate to an agreement to provide testimony or write a report for your litigation. In the majority of situations, it is harmful to therapeutic goals for me to be directly involved in your litigation. Therefore, I will actively seek to stay out of your litigation and focus solely on therapeutic goals and intervention. Healing doesn’t happen in a courtroom.

If you choose to involve me in your litigation, it is important for you to understand that therapy fees are not the same as fees related to litigation or other legal involvement. My hourly charge for all time spent outside of therapy sessions related to court cases or litigation is a non-refundable $1,500 for up to 4 hours of my time and $500 per hour after that. You also agree by your signature below to make the required payment for the time I must spend dealing with your litigation, including but not limited to speaking with attorneys, writing treatment summaries, responding to a subpoena, and attending a court hearing to give testimony. If I am subpoenaed to provide records or testimony in violation of this agreement and against my stated wishes, you also agree to pay for all my professional time, including but not limited to preparation, record review, transportation charges (door-to-door), waiting time, and time spent testifying in court or deposition regardless of which party issued the subpoena or requires me to testify.

If I am required to testify in court or give a deposition in Bexar County, I will require a retainer in the amount of $1800 (6 hours at $300 per hour), which will include preparation time, travel time (door-to-door), and attendance at any legal proceeding. If I am required to testify in court or give a deposition outside Bexar County, I will require a retainer in the amount of $2400 (8 hours at $300 per hour), which will include preparation time, travel time (door-to-door), and attendance at any legal proceeding. By your signature below, you agree to pay the applicable retainer no later than 48 hours prior to the litigation event.

If the testimony or deposition exceeds 6 hours in Bexar county or 8 hours outside Bexar county, your credit card on file will be charged $300 per hour for every hour spent at any legal proceeding, including court or deposition. By your signature below, you agree that I will issue an itemized statement showing the breakdown of time and you further agree to that the amount of the invoice can be charged to the credit card on file. When I go to court or give a deposition, I have to clear my schedule and not see other clients so there is a 48-hour cancellation policy for court and depositions. For example, if the court appearance or deposition is scheduled for a Monday, I must be notified of any cancellation by Noon on the Thursday before. Any cancellations that occur within that 48-hour time frame are non-refundable. I will accept credit card, money order or cashier’s check for payment of fees related to court appearances or deposition. No personal checks will be accepted for these services. All payments are due 48 hours prior to the scheduled court appearance or deposition. By your signature below, you expressly authorize me to charge the credit card on file for any fees related to litigation and court appearances unless you notify me that you intend to make payment by cash, money order or cashier’s check. Finally, if I am subpoenaed to provide records or testimony in violation of this agreement and against my stated wishes, I reserve the right to terminate our professional, therapeutic relationship immediately and refer you to other mental health providers.

Client 1 ______________________________  _________________________________

Printed Name     Signature

Client 2 ______________________________  _________________________________

Printed Name     Signature

_____________________________________  ____________________________

D. Allen Novian, Ph.D., LMFT-S   Date

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