Good Faith Estimate
You are entitled to receive this Good Faith Estimate of what the charges could be for psychotherapy services provided to you. While it is not possible to know, in advance, how many psychotherapy sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services provided. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.
A Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. An estimate is not a contract and does not obligate you to obtain any services from the provider listed, nor does it include any services rendered to you that are not identified here. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. There may be additional items or services recommended as part of your care that must be scheduled or requested separately and are not reflected in this Good Faith Estimate. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your therapist. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. You are encouraged to speak with your provider at any time about any questions you may have regarding your treatment plan, or the information provided to you in this Good Faith Estimate.
Every client's therapy journey is unique. How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including, but not limited to: severity of symptoms, your personal availability and life circumstances, therapist availability, ongoing life challenges, the nature of your specific challenges and how you address them, and personal finances. You and your therapist will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge.
Provider Name: Perennial Counseling & Consulting PLLC
Tax ID Number: 82-3274989
Type 2 NPI Number: 1689186330
Individual Provider Name: Amanda Bull MA LCPC
License Number: 180.008030
Type 1 NPI Number: 1366719734
Provider Address: In-person sessions are at 3057 N Rockwell, Suite 224, Chicago IL 60647. Virtual sessions are provided throughout the entire state of Illinois via our secure HIPAA compliant platform: Google Meets, TherapyNotes, or audio via cell phone.
Provider Phone Number: 773-687-6065
Common Services / CPT Codes used at Perennial Counseling & Consulting:
90791 Intake Assessment (45-55 min)
90837 Psychotherapy 60 min (53+ minutes)
90834 Psychotherapy 45 min (38 - 52 minutes)
90832 Psychotherapy 30 min (16 to 37 minutes)
Common Diagnosis Codes at Perennial:
Please note the following codes are not an exhaustive list. Diagnosis codes change on a variety of factors and should be discussed with your therapist. A diagnosis is required for clinical, ethical, legal, and insurance requirements, as well as the "No Surprise Act."
F43.23 Adjustment Disorder with mixed anxiety and depressed mood
F41.1 Generalized Anxiety Disorder (GAD)
F33.0 Major Depressive Disorder (MDD)
F34.1 Persistent Depressive Disorder
F31.11 Bipolar Disorder
F43.12 Post-Traumatic Stress Disorder (PTSD)
Costs at Perennial when working with a Licensed Clinical Professional Counselor (LCPC):
Intake Session: $200
Individual Session: $175
Occasionally we see clients for less than the above amounts, under special circumstances. The listed prices are the absolute most that a client would pay for a session out of pocket.
Estimated Costs of Services:
The majority of our clients are seen on a once per week basis. Clients are never seen for sessions more than twice in a week and rarely less than once every two weeks. Expected costs are based on weekly therapy. To calculate how much the cost will be if a client comes twice per week, please multiply each number by two. To calculate how much it will cost if a client comes once every other week, please divide each number by two.
Individual Psychotherapy, One Per Week, Annually: $9100
You have the right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) 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 Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
For questions or more information about your right to a Good Faith Estimate or the dispute resolution process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.