Good Faith Estimate of Expected Charges
Otilia Rowe, LCSW
Otilia Psychotherapy
Licensed Clinical Social Worker
Brooklyn, New York
hello@otiliapsychotherapy.com
Your Right to a Good Faith Estimate
Under the federal No Surprises Act, individuals who do not have health insurance or who choose not to use their health insurance are entitled to receive a Good Faith Estimate of the expected cost of health care services.
This Good Faith Estimate provides an estimate of the charges that are reasonably expected for psychotherapy services provided by Otilia Psychotherapy based on the information available at the time this estimate is prepared.
Because psychotherapy is individualized, the frequency and duration of treatment may vary based on your needs, goals, progress, and clinical circumstances. This estimate is provided for financial planning purposes and is not a recommendation that you attend a specific number of sessions.
Standard Fees
Initial Evaluation
Psychiatric Diagnostic Evaluation — CPT Code 90791
Fee: $225
The initial evaluation allows us to discuss your presenting concerns, treatment history, goals, and needs and determine whether ongoing therapy is appropriate.
Individual Psychotherapy
45-Minute Individual Psychotherapy Session — CPT Code 90834
Fee: $225 per session
Most clients begin therapy with weekly sessions. The frequency of sessions will be determined collaboratively based on your individual needs and treatment goals.
Estimated Cost of Ongoing Therapy
Weekly therapy: Approximately 4–5 sessions per month
Estimated monthly cost: $900–$1,125
Biweekly therapy: Approximately 2–3 sessions per month
Estimated monthly cost: $450–$675
These estimates are based on the current fee of $225 per session. Your actual costs will depend on the number and frequency of sessions you attend.
Important Information
This Good Faith Estimate is not a contract and does not obligate you to receive services from Otilia Psychotherapy.
You are not required to attend a predetermined number of therapy sessions. Your treatment frequency will be discussed collaboratively and may change as your needs and goals change.
The estimate does not include services that were not reasonably expected at the time the estimate was prepared, including services that may become necessary because of changes in your clinical needs or circumstances.
My current fee is $225 per 45-minute psychotherapy session. You will be notified in advance of any changes to my standard fee.
If you have questions about your estimated costs or your treatment frequency, you are encouraged to discuss them with me at any time.
Your Right to Dispute a Bill
If you are billed for substantially more than the amount estimated in your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process, as applicable under federal law.
For more information about your rights under the No Surprises Act and Good Faith Estimate requirements, visit:
You should keep a copy of this Good Faith Estimate for your records.
This Good Faith Estimate is provided for informational and financial planning purposes and does not constitute a guarantee of the number or frequency of services that will be provided.
Otilia Rowe, LCSW
Otilia Psychotherapy
Brooklyn, New York