1. Purpose of This Good Faith Estimate
Under the No Surprises Act (effective January 1, 2022), health care providers are required to provide clients who are uninsured or not using insurance with a Good Faith Estimate of expected charges for non-emergency health care services, including mental health services).
This Good Faith Estimate provides a reasonable projection of the costs of services based on the information available at the time of the estimate.
2. Provider Information
Provider Name: April Williamson, MA, LMFT
Practice Name: Kindred Counseling
License: Minnesota 4668
NPI Number: 1811785645
Phone: 612-412-1384
Location: Telehealth and In Person
3. Services and Rat1es:
| CPT Code | Number of Sessions | Rate per Session | Total |
|---|---|---|---|
| 90791 | 1 | $200 | $200 |
| 90837 | 40 | $180 | $7,200 |
| 90834 | 10 | $160 | $1,600 |
| 90832 | 5 | $100 | $500 |
| 90846 | 4 | $190 | $760 |
| 90847 | 2 | $190 | $380 |
| Grand Total | $10,640 | ||
(Note: Costs may vary depending on client needs and frequency of services)
4. Disclaimer
- This estimate is not a contract and does not obligate the client to receive services.
- Actual charges may differ if additional services are provided or if frequency changes.
- If the actual billed charges are $400 or more than this estimate, the client may initiate a disput resolution process through the Department of Health and Human Services (HHS).
- You have the right to receive a written explanation of the difference in cost.
- This estimate is valid for 12 months from the date of issue unless otherwise updated.