Good Faith Estimate

In compliance with the No Surprises Act (H.R. 133), all healthcare providers, facilities, health plans and insurers are required to provide patients with a Good Faith Estimate prior to services being rendered. This allows uninsured or self-pay individuals to have access to health care pricing before receiving care.

Individual Therapy

Provider name and credentials:
MacKenzie Bradke, LCSW
License - Missouri - 2005025550
License - Arizona - LCSW-19503
NPI: 1528072832
EIN: 20-8842911

The service provided at Follow Your Arrow Counseling (dba Bradke Counseling, LLC) include the following:
Individual therapy

Common services and service codes used at Follow Your Arrow Counseling:
90791: Initial Intake Assessment
90837: 55 minute individual session
90834: 45 minute individual session
90847: 55 minute family therapy session

Common diagnoses used at Follow Your Arrow Counseling:
F41. 1 Generalized Anxiety Disorder
F43. 20 Adjustment Disorder, unspecified
F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood
Z60.0 Problems of adjustment to life-cycle transitions
Z56.6 Other physical and mental strain related to work
Z56.9 Unspecified problems related to employment
Z63.0 Problems in relationship with spouse or partner
Z63.4 Disappearance and death of family member

A note about diagnosis:
At Follow Your Arrow Counseling, I do not typically diagnose clients unless I believe a specific diagnosis to be accurate after an evaluation and, after consultation with the client, I believe that having a mental health diagnosis is likely in the client's best interest. Instead of diagnostic codes, I typically use Z codes, which highlight general areas of concern to be addressed in therapy. Please speak to your therapist about this practice if you have any questions or concerns.

Where services will be rendered:
In-person at Follow Your Arrow Counseling
Online through a secure, HIPPA-compliant, video-based platform

At Follow Your Arrow Counseling I recognize that every client's therapy journey is unique. How long you need to engage in therapy and how often you participate in sessions will be influenced by many factors including:
Your schedule and life circumstances
Therapist availability
Ongoing life challenges
The nature of your specific challenges and how you address them

You and your therapist will continually assess appropriate frequency of therapy and will work together to determine when you have met your treatment goals and your therapy journey is complete.

Below you will see how much one (1) month of therapy will cost if you met with your therapist each week.

I recognize that not all clients will meet with their therapist on a weekly basis. At Follwo Your Arrow Counseling each client has the ability to determine, along with their therapist, the frequency of sessions that are most clinically appropriate for their situation.

For Individuals

The current rate for 2024 for individual sessions with Follow Your Arrow Counseling are as follows:

55 minute individual session: $170

For individuals, if you met with your therapist weekly for one month (a four week month), your total would be $600. That is 4 (four) sessions at $150 per session.

Disclaimer

The Good Faith Estimate is not a contract. It does not require you to obtain the items or services from Follow Your Arrow Counseling. Additionally, the information provided in this good faith estimate is only an estimate. Actual items, services or charges may differ from the Good Faith Estimate.

This Good Faith Estimate shows the costs of items and services that are
reasonably expected for your health care needs for an item or service. The
estimate is based on information known at the time the estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs
that may arise during treatment. You could be charged more if complications or
special circumstances occur. If this happens, federal law allows you to dispute
(appeal) the bill.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

You may contact the health care provider or facility listed to let them know the
billed charges are higher than the Good Faith Estimate. You can ask them to
update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask
if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of
Health and Human Services (HHS). If you choose to use the dispute resolution
process, you must start the dispute process within 120 calendar days (about 4
months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your
dispute agrees with you, you will have to pay the price on this Good Faith
Estimate. If the agency disagrees with you and agrees with the health care
provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to
www.cms.gov/nosurprises or call 800-368-1019.

For questions or more information about your right to a Good Faith Estimate
or the dispute process, visit www.cms.gov/nosurprises or call 800-368-1019.

Keep a copy of this Good Faith Estimate in a safe place or take
pictures of it. You may need it if you are billed a higher amount.