Good Faith Estimate

DVH NP IN PSYCHIATRY SERVICES, PLLC

Transparent Cost Estimation for Services 

This document outlines our pricing structure, for one session, for uninsured or out-of-network patients until 10/01/2024, providing a clear expectation of likely costs for psychiatric services.

  • Initial psychiatric evaluation: $155
  • Psychiatric medication management per appointment: $75
  • Combined psychiatric medication management and psychotherapy (30 minutes) per appointment: $125
  • Combined psychiatric medication management and psychotherapy (45 minutes) per appointment: $155
  • Combined psychiatric medication management and psychotherapy (60 minutes) per appointment: $225

At our clinic, we prioritize the trust and well-being of our patients. Insured patients should note that they are responsible for all charges not covered by insurance. This might include costs exceeding the rates mentioned for uninsured patients. Patients agree to address any balance as per our payment guidelines.

Contact

If you have questions about this good faith estimate, please contact Dustin Von Holten, NPP-BC at (347) 573-9479 or via email at office@dvhnpinpsychiatryservices.com.

Details of the Estimate

The estimated costs are valid from 01/01/2023 until 04/01/2024 unless I send you an updated Estimate.

Psychiatric Nurse Practitioner providing services:

  • Name: Dustin Von Holten, NPP-BC
  • NPI number: 1841720521

Disclaimer and Rights:

This Good Faith Estimate reflects the expected costs of services based on current knowledge. It does not include unforeseen expenses that may arise during treatment. Should costs exceed this estimate by $400 or more, federal law permits you to dispute the bill. For disputes, contact the provider or initiate a resolution process with the U.S. Department of Health and Human Services. A $25 fee applies to the dispute process. For more information about this process and your rights, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.

This document is not a contract and does not obligate you to the services listed. Keep a copy of this estimate for reference in case of billing discrepancies.