Our Sliding Scale / No Surprises Act

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 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, visit www.cms.gov/nosurprises or call 618-665-3050.

Sliding Scale Fee for Counseling Sessions

Combined Annual Family Income

(Annually)……………………………………………(Fee)

$0-$24,999………………………………………..$50

$25,000-$34,999…………………………..$60

$35,000-$44,999…………………………..$70

$45,000-$54,999…………………………..$80

$55,000-$64,999…………………………..$90

$65,000-$74,999…………………………...$100

$75,000-$84,999…………………………...$110

$85,000-$94,999…………………………..$120

$95,000-$109,000………………………...$130

$110,000-$124,999…………………………$140

$125,000-$149,999……………………….$150

$150,000-$174,999……………………….$160

$175,000-$199,999……………………….$170

$200,000 and up………………………...$180

NO SHOW/LATE CANCELLATION FEE - $50 fee for less than a 24-hour notice of cancellation.

CREDIT CARD FEE - There is a 3% fee for using credit cards.

NOTE - The client understands he/she is expected to pay the amount listed on the Sliding Scale Fee per session. The amount is based on the client’s family’s combined annual income.

Fees for Additional Counseling Services

ALL COURT CASES: The cost for anything required for Court Cases is $400 per hour which includes:

  1. Writing of letters to attorneys and case workers, etc.

  2. Review of your case for witness testimony.

  3. Travel time from when I leave my door to when I get back to the office.

  4. Pre-payment is required BEFORE going to court with a minimum of $2,000 due prior to the date of court. If there is an overpayment, a refund will be sent to you; if there is more due after court, you will receive a bill which will need to be paid prior to scheduling the next appointment.

  5. The court date must be established with at least a 4-week advance notice.

  6. Other fees will be added as they are needed.

NOTE -The client understands he/she is expected to pay the Court Fees of $2,000 prior to the court date. Upfront payment (made to Grace and Truth Counseling) and the client’s signature are required before any work is committed towards the court case.