Fees & Insurance
So glad you’ve considered placing your trust in Arch & Sparrow!
The fee for an individual counseling session is $150. Payment is due at the time of your appointment.
All major credit and debit cards are accepted. Many Health Savings Accounts and Flexible Spending Accounts can be used for payment for counseling visits.
I am in network with the following providers:
Aetna Commercial Plan
Aetna State Health Plan
Carelon
Cigna
Quest
Soon I will be in network with additional insurance companies:
Blue Cross Blue Shield
United HealthCare
Ambetter
Oxford
Oscar
Optum (all affiliates)
Please ensure that I am in-network with your specific insurance plan. You can find this information on your insurance company’s website or call their customer service number. The billing codes used are 90791 (for intake assessment) and 90837, 90834, and 90847 (for follow-up sessions).
For insurance plans for which I am not in network, I can provide a “superbill” to submit to your insurance company for reimbursement.
I value your time and mine. The following guidelines help me provide you with a supportive, consistent experience.
All clients are required to keep a card on file for services and applicable fees.
Outstanding balances are not allowed.
A 48-hour notice is required for cancellations.
Missed appointments or late cancellations will occur a $150 fee, not covered by insurance.
No Surprises Act / Good Faith Estimate
The following is a Good Faith Estimate of healthcare costs and services for clients choosing self-pay:
90791 Psychotherapy Assessment – $150
90837, 90834, 90847 Telehealth Therapy – $150
You may multiply the above service rate times the number of weeks you plan to attend counseling. You are not obligated to attend sessions weekly. You may be charged LESS than what is estimated above. The estimated costs are valid for 12 months from the date of the Good Faith Estimate.
The Good Faith Estimate requires a minimum of one diagnosis code. This is not a clinical diagnosis which will occur after your clinical assessment. Your Good Faith Estimate diagnosis is Z73.3 – Stress not elsewhere classified. You can decline a clinical diagnosis at any time. Your diagnosis may change once your clinical assessment is complete. You will not receive a new Good Faith Estimate.
Services will be provided via telehealth by
Arch & Sparrow Counseling PLLC
Winston-Salem, NC 27106
336.995.0054
jessie@archandsparrow.com
Disclaimer
This Good Faith Estimate outlines the anticipated costs of the health care services and items related to your treatment needs. The estimate is based on the information available at the time it was prepared. Please note that additional or unforeseen costs may arise during the course of treatment due to complications or special circumstances.
If your final bill is at least $400 higher than the amount listed on this Good Faith Estimate, you have the right under federal law to dispute the charges. In that situation, you may contact Arch & Sparrow to discuss the difference between the estimate and the billed amount. You may request that the bill be adjusted to reflect the estimate, negotiate the charges, or ask whether financial assistance options are available.
You also have the option to begin a formal dispute resolution process through the U.S. Department of Health and Human Services (HHS). This process must be initiated within 120 calendar days of receiving the original bill. A $25 administrative fee is required to begin the dispute process. If the reviewing agency determines that the estimate should be honored, you will only be responsible for paying the amount listed on the Good Faith Estimate. If the agency agrees with the provider or facility, you may be responsible for the higher billed amount.
For additional information about your rights regarding Good Faith Estimates or instructions on how to begin the dispute process, visit CMS No Surprises Information Page or contact HHS at (800) 368-1019.
Be sure to keep a copy of this Good Faith Estimate for your records. It may be important if you need to dispute a future bill.