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Payment Information/Session fees

 

I accept self-pay, and out of network benefits when applicable. Payment is due at time of service and can be completed through credit cards and health savings accounts. 

 

 

Psychiatric Intake: $225

Family therapy/Couples/Parent Coaching: $200

Individual Session: $175

Missed Session/Late Cancellation: Full session fee

No surprises act/Good faith estimate​

Notice to clients and prospective clients:

​​

  • Under the law, health care providers need to give clients who do not have insurance or who are not using insurance, an estimate of the expected charges for medical services, including psychotherapy services. 

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

  • You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.  

  • 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. 

  • For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.

985 Washington Street 

Braintree, MA 02184

email: cpagliaro@caseypsychotherapyservices.com

phone: 857-267-1143

Please do not include confidential information on this form.

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© 2021 by Casey Cantelli, LMFT

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