Good Faith Estimate.
Good Faith Estimate for Therapy Services
Rodriguez Psychological Services PLLC
228 Park Ave S PMB 505797
New York, NY 10003-1502 US
📧 ashleyrodriguezphd@gmail.com
Date of Good Faith Estimate: 7/26/2025- present
Explanation for New Clients:
This Good Faith Estimate outlines expected costs for psychotherapy services. While every client’s needs vary, most therapy clients attend between 10–40 sessions, depending on goals, complexity, and support needed. My standard fee is $300 per session.
Explanation for Ongoing Clients:
The estimate below reflects anticipated care over the next 12 months. However, this may change based on how treatment evolves.
If you have any questions about this estimate, contact me directly at ashleyrodriguezphd@gmail.com.
Provider Insurance Participation
Dr. Ashley Rodriguez is currently in network with the following insurance providers:
Aetna
Empire Blue Cross Blue Shield
Cigna
Optum
For clients using out-of-network benefits, I can provide a superbill for potential reimbursement.
Details of the Estimate
Total Estimated Cost: $3,300 – $12,300
Provider Information
Name: Ashley Rodriguez, PhD, PMH-C
Business Name: Rodriguez Psychological Services PLLC
NPI: 1689100588
Address: 228 Park Ave S PMB 505797, New York, NY 10003-1502 US
Required Disclaimer
This Good Faith Estimate shows the costs of services that are reasonably expected for your mental health needs. The estimate is based on the information available at the time it was created.
It does not include unexpected costs that could arise. If you are billed $400 or more above this estimate, you have the right to dispute the bill under federal law.
You may contact me to review or adjust charges or submit a formal dispute with the U.S. Department of Health and Human Services (HHS) at www.cms.gov/nosurprises or 1-800-985-3059. There is a $25 fee to use the dispute process.
This estimate is not a contract and does not obligate you to receive services.
