Provider name: Lisa Delaplace, MSW, LICSW
Provider/facility type: Wise Mind Relationship Counseling PLLC
Street address: 291 S. Preston Rd. Suite 410
City: Prosper
State: TX
ZIP code: 75078
Contact person: Lisa Delaplace, MSW, LICSW
Phone: 425-686-5631
Email: [email protected]
National Provider Identifier (NPI): 1447659511
Details of Services and Items for Wise Mind Relationship Counseling PLLC
Expected cost for INDIVIDUAL or Couples therapy if not using insurance. Note: This quote is for weekly and biweekly 55 minute sessions. Your session frequency may vary depending on need. (Yearly estimate is based on taking 8 weeks of vacation per year.) Ninety minute sessions available as needed at a rate of 255.00.
Cost for each 55 minute session: 170.00
Cost per month Biweekly: 340.00
cost Per month weekly: 680.00
Cost per year with biweekly sessions (23 sessions) 3,910.00
Cost Per Year Weekl sessions(46 sessions): 7820.00
Other fees:
No Show fee: 170.00
Late Cancellation fee (within 24 hours of scheduled appointment) 85.00
Disclaimer
Each person’s journey is unique. How long and how often you need to engage in therapy can be influenced by things like your schedule, therapist’s availability, ongoing life challenges, personal finances and changing needs. We will adjust the frequency of therapy as needed which will affect the costs. My treatment approach typically has clients starting out with weekly therapy and reducing frequency as needed throughout our work together.
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. 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. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
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.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.