Good Faith Estimate (Surprise Billing Protection)

Applies to direct-pay patients

The purpose of this section is to inform you regarding legal protections (No Surprises Act) from unexpected medical bills, which state that health care providers need to give patients who don’t have insurance or who are not using insurance, upon request or when scheduling an item or service, an estimate (aka “Good Faith Estimate”) of the bill for medical items and services. 

Dr. Ho’s services will likely be more expensive than receiving care from a provider or facility that accepts your insurance plan. You are not required to sign this form or receive care from out-of-network physicians like Dr. Ho.

Good Faith Estimate (GFE): Treatment plans are dependent on the severity and complexity of presenting psychiatric issues. Patients can be seen monthly, every two weeks, every week or sometimes several times per week, depending on need. Dr. Ho will review with you the recommendation for treatment including medication (if warranted) and/or psychotherapy, frequency of appointments and possible duration of care. Dr. Ho will never require that you receive the treatment from this practice, but if you choose to do so, your estimated cost can be found by multiplying the service cost above by the frequency of recommended treatment. Length of treatment can vary from weeks to years, depending on the diagnosis and course. Twelve months of treatment with Dr. Ho may cost between $400 - $700 (initial fee) plus $3000 (fees for once-monthly 30-minute visits for 12 months). These are estimates as each patient requires a nuanced treatment plan. Please contact Dr. Ho if you have further questions about this notice and estimate. You may also visit https://www.cms.gov/nosurprises for more information about your rights under federal law.