9951 Mickelberry Rd NW,
Silverdale, WA. 98383
Sally McIntosh Stoehr, LMFT
Child and Family Therapist
Fees And Insurance
Notice of Right to Receive a Good Faith Estimate
As of June 1, 2021, my fee schedule is as follows:
Initial “intake” session (50-60 minutes) - $135.00
individual session (50-60 minutes) - $125.00
individual session (80-90 minutes) - $187.50
family session (50-60 minutes) - $125.00
The following services are not generally billable to insurance and will be charged to you:
Out of office work (court, school visit, etc) - $275.00 per hour
Write report or letter - $125.00 per hour (except for court proceedings)
Telephone calls (longer than 10 minutes) - $35 per 15 minutes
Email (longer than 10 minutes) -$35 per 15 minutes
Routine calls and email fewer than 10 minutes and time spent scheduling appointments will not be billed to you.
I request a credit or HSA card on file for payment of copays, missed appointment and consultation fees not covered by insurance. Please complete authorization form or discuss with your provider at initial appointment.
At this time I am contracted as an in-network provider with Premera Blue Cross. I will submit the claim to them on your behalf.
I am am qualified as an out-of-network provider with many companies should you have that kind of benefit. For all other insurance companies I require payment at the time of service and will provide you with a statement to submit to them for reiumbursement.
It is your responsibility to check with your insurance carrier for specific information regarding your benefit, copayments, and annual deductible.
All fees, including out of network benefits, copayments/deductible are due at the time of service.
Please be aware that authorization for treatment by your insurance carrier does not insure payment to a provider. If your insurance carrier refuses payment for any reason, you are responsible for your bill.
If you plan to seek reimbursement from your insurance company, please be advised that most insurance companies require a statement of the type of services rendered and a diagnosis. In addition, some carriers require more detailed information such as progress reports or treatment summaries. Please sign an informed consent for release of information to authorize me to release this information to them.
Under Section 2799B-6 of the Public Health Services Act (PHSA), health care providers and health care facilities are required to inform individuals who are NOT ENROLLED in an insurance plan or cover or a Federal health care program, or NOT SEEKING TO FILE A CLAIM with their insurance plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a "good Faith Estimate (GFE) of expected charges.
Note: The PHSA and GFE does not apply currently to any clients who ARE USING insurance benefits, including Out of Network benefits (i.e. seeking reimbursement on your own from your insurance company).
The GFE shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate based on information known at the time the estimate was created.
More information can be found here:
In the event you cannot keep an appointment for any reason, please give at least 24 hours notice of cancellation, otherwise you will be charged the full fee for the time I have reserved for you (this is not covered by insurance).
Payment of copays, insurance deductible or non-covered services are due at the time of the session. I accept HSA cards, as well as Visa, Mastercard and American Express.
Payment and Fees