Good Faith Estimate Notice

Wildroot Relationship Therapy PLLC

Kate Tune, LMFT

Licensed Marriage and Family Therapist (IL & CO)

Location: Oswego, IL

Contact: admin@wildroottherapyil.com | (630) 618-2208

NPI: 1639096985

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 bill for medical items and services, including psychotherapy services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare items or 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.

How Estimates Work at Wildroot Relationship Therapy

Every client paying out-of-pocket will receive a personalized, written Good Faith Estimate prior to starting therapy. Below are the standard self-pay rates and billing codes (CPT codes) for standard services:

  • Individual Therapy (50 mins): $170 (CPT Code: 90837)

  • Couples / Family Therapy (50 mins): $185 (CPT Code: 90847)

  • Initial Intake Assessment: $170/$185 (CPT Code: 90791)

Note on Duration and Frequency:

Therapy is tailored to your unique needs. Frequency (e.g., weekly, bi-weekly) and total duration of treatment depend on your individual goals and ongoing progress. You have the right to modify frequency or pause/terminate therapy at any time.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.