Last Updated: May 18, 2026   |   One Drop at a Time | Stacey Seibold, LCSW LLC

Good Faith Estimate Notice

Your Right to Receive a Good Faith Estimate

Under the law, health care providers must provide clients who do not have insurance or who are not using insurance with an estimate of expected charges for medical and mental health services.

You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency healthcare services, including psychotherapy services.

What Is Included

A Good Faith Estimate may include:

  • Session fees

  • Intake fees

  • Ketamine preparation or integration sessions

  • Medical session support fees

  • Other reasonably expected costs related to treatment

Current Self-Pay Rates

Individual Therapy

  • $180 per 53–60 minute session

Couples Therapy

  • $225 per 53–60 minute session

Ketamine Preparation & Integration Sessions

  • Individual sessions: $180

  • Couples sessions: $225

Ketamine-Assisted Medical Support Sessions

  • $360 for up to 2 hours

  • $45 per additional 15 minutes thereafter

Sliding scale options may be available for ketamine-assisted psychotherapy services only and are determined on a case-by-case basis.

Insurance

The Practice currently accepts:

  • Blue Cross Blue Shield PPO

  • Blue Choice

  • United Healthcare / Optum

  • Aetna

  • Cigna / Evernorth

Clients are responsible for understanding their insurance coverage, deductibles, copays, and reimbursement eligibility.

Questions or Disputes

If you receive a bill that is substantially higher than your Good Faith Estimate, you may have the right to dispute the bill under federal law.

For questions about your estimate, contact:

One Drop at a Time
Chicago, Illinois
Email: staceyseiboldlcsw@gmail.com
Website: staceyseiboldlcsw.com