Good Faith Estimate for Kairos Collective LLC
Rev. 5-2026
Kairos Collective LLC
Virtual Therapy from Indiana, USA
NPI: 1972863744
TIN: 42-2864134
Introduction
The estimate below is the cost that is likely for most new clients. Until we complete your initial evaluation & intake, and we start to work together, I will not have a clear picture of your specific diagnosis or issues.
I usually treat clients who have a history of significant depression, anxiety and trauma and who are managing major upheavals/life transitions; therefore, my services generally range from 20-52 sessions (4 to 12 months). It is not unusual for clients to choose to maintain sessions longer.
Because clients present with individual needs, we may need additional frequency of sessions or different modalities during the time covered by this estimate.
If you have questions about this estimate, please contact me at shannan@kairoscollectivellc.com
Estimate of Costs of Services
- Intake Interview/Diagnostic Evaluation, CPT 90791 – Qty 1 = $190
- Ongoing Psychotherapy Sessions 90834, 90837, 90785 – Qty 1-52 weekly sessions
- Cost per unit: 90834 = $90, 90837 = $180-$278,
- Extended EMDR – $190-$250/hr
- Day-long Intensives – $600-900/day
- Multiple-day Retreats – $2,000-$3,000
Expected Total Yearly Cost Range from $3,300 to $30,000 depending on certified modalities used and extra time for sessions.
NOTE: Kairos Collective Does Not Contract with Any Insurance Company
Dispute Process
If your total yearly billed services amount exceeds the yearly Good Faith Estimate by $400, you have the right to dispute the bill.
You may contact us at shannan@kairoscollectivellc.com if billed charges are higher than the Good Faith Estimate. You can request an update to 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 for 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 CMS at 1-800-985-3059.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059.
Summary
This Good Faith Estimate shows an estimate of yearly costs of services that are reasonably expected for the desired services for addressing your mental health care needs.
Optional services like retreats, etc. have been included for pricing transparency, and are not considered standard treatment. The estimate is based on the information known to Kairos Collective when the estimate was provided.
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.
This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.
