Good Faith Estimate
Good Faith Estimate for Therapy Services
Provider: Shay DuBois, License Number 1000049, Title Licensed Clinical Social Worker
Practice Address: 1286 University Ave, #1020, San Diego CA 92103-3312
Contact Information: 858 321 6355, shay@overcomeanxietytrauma.com
Service Information
This Good Faith Estimate provides an estimate of the cost of therapy services provided by Shay DuBois. This estimate is required by the No Surprises Act, ensuring transparency for self-pay and uninsured clients regarding potential charges.
Estimated Rate per Session: $267.00 (50-minute session)
Anticipated Services and Costs
The number of sessions may vary based on individual needs and therapeutic goals. Below are potential cost scenarios based on commonly recommended frequency and duration of therapy sessions.
| session type | cost per session | estimated cost for 3 months | estimated cost for 6 months | estimated cost for 12 months |
| individual therapy | $267.00 | (weekly 4x/mo) $3204.00 | (weekly 4x/mo) $6408.00 | (weekly 4x/mo) $12816.00 |
Important Notes
– Duration of Treatment: Therapy duration and frequency are based on the unique needs and preferences of each client. This Good Faith Estimate reflects common scenarios, but the actual length of therapy may vary.
– Additional Sessions or Services: If additional sessions or services are required, this estimate will be updated to reflect those changes.
– Adjustments: Should treatment goals or needs evolve, the GFE will be reviewed and updated upon request.
Payment, Cancellation and Other Fees
Self-pay: I do not take insurance. Fees are paid directly by the client.
Superbills: A superbill is provided on request so you can submit for out-of-network reimbursement if your plan offers it. Reimbursement is not guaranteed.
Cancellation: Please give at least 48 hours’ notice to cancel or reschedule a session. If a session is cancelled with less than 48 hours’ notice, the full session fee is charged.
Free consultation: The initial 15-minute consultation is free.
Longer sessions and intensives: Brainspotting intensives (2 to 8 hours, sometimes split over two days) and ketamine-assisted psychotherapy (KAP) sessions are billed at the session fee ($267.00) multiplied by the number of hours.
Neurofeedback: $267.00 intake, then $300.00 per month for the at-home service, plus one required monthly review billed at the regular session fee (this can be split into two 30-minute check-ins).
Your Rights
You have the right to receive a Good Faith Estimate before beginning services, and you may request a new GFE at any time if your treatment plan changes. For any billing or estimate questions, please contact us at 858-321-6355 or shay@overcomeanxietytrauma.com.