Access to Care & Financial Transparency
Sliding Scale
At Merkaba Integrative Psychiatry, I believe healing should be accessible, respectful, and sustainable. For clients who are paying out-of-pocket, I offer Good Faith Estimates and a sliding scale: a tiered fee structure that helps match the cost of care to your current financial reality.
What is a sliding scale?
A sliding scale provides multiple fee tiers for the same high-quality service. It’s designed to make care more attainable for people with fewer financial resources, while allowing those with greater financial flexibility to support the long-term sustainability of the practice.
Why I offer this
- Access: reduce financial barriers to care
- Equity: honor real differences in resources and cost of living
- Dignity: support private, non-shaming conversations about finances
- Sustainability: keep high-quality, consistent care available over time
I use a trust-based model. You choose the tier that best fits your situation. I do not require income verification.
How to choose your tier
Use these examples as a guide. Choose the tier that feels honest and sustainable for you right now.
Tier A: Standard / Full Fee
This tier is a fit if you:
- have stable income and predictable expenses
- can pay for care without significant stress
- have savings, financial cushion, or access to support if needed
- can meet needs comfortably (housing, food, healthcare, transportation)
Tier B: Supported Access
This tier is a fit if you:
- can meet needs, but the full fee would be a meaningful stretch
- carry significant expenses (debt, medical costs, childcare, housing burden)
- have limited savings or are rebuilding financially
- can pay for care with planning and some sacrifices
Tier C: Expanded Access
This tier is a fit if you:
- are underemployed, unemployed, or have unstable income
- would be forced to choose between care and essentials
- have little/no savings or financial safety net
- are experiencing significant financial strain
A helpful check:
If paying for care means cutting back on non-essentials (sacrifice), Tier B may fit.
If paying would jeopardize essentials (hardship), Tier C is designed for you.
Good Faith Estimates (GFE)
As part of my commitment to transparency, trust, and informed consent, I provide Good Faith Estimates for services when required by law and whenever it is clinically and ethically appropriate to do so.
What is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written explanation of the expected cost of your care before services are provided. It is meant to help you understand what you may be charged for a specific service or course of treatment.
Good Faith Estimates are required under the No Surprises Act for individuals who:
- are uninsured, or
- are self-pay (not using insurance for a particular service)
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Why I provide Good Faith Estimates
I believe that clarity around cost is part of ethical, respectful care. Providing a Good Faith Estimate allows you to:
- understand anticipated costs before starting care
- plan financially with fewer surprises
- ask questions and make informed decisions
- engage in care from a place of trust and safety
For clients using a sliding scale, the Good Faith Estimate reflects the fee tier you have selected, not the full standard rate.
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What a Good Faith Estimate includes
A Good Faith Estimate typically outlines:
- the type of service being provided
- the expected fee per session or service
- an estimate of total costs over a defined time period
- any assumptions used to create the estimate
Because mental health care is individualized, actual costs may vary depending on clinical needs, changes in treatment frequency, or additional services requested.
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Important rights under the No Surprises Act
If you receive a Good Faith Estimate and are billed $400 or more above the estimated total, you have the right to dispute the bill.
You may start a dispute resolution process by contacting the U.S. Department of Health and Human Services (HHS).
More information is available at:
www.cms.gov/nosurprises
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My approach
- Good Faith Estimates are provided in writing
- Estimates are updated if your treatment plan changes
- Questions about fees are welcomed and handled respectfully
- Financial conversations are kept confidential and non-judgmental
If you have questions about your estimate or would like one before scheduling, please let me know — I’m happy to help.