“No Surprises” Act and Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.

Rates

$120 - $200

Insurance

Depending on your current health insurance provider or employee benefit plan, it is possible for services to be covered in full or in part. Please contact your provider to verify how your plan compensates you for psychotherapy services.

I’d recommend that you ask your insurance provide these questions below to help determine your benefits:

— Does my health insurance plan include mental health benefits?

— Is my provider in network for my insurance?

— Does my insurance reimburse for out-of-network behavioral health services?

— What is my annual policy renewal/start date?

— Do I have a deductible or out-of-pocket requirement? If so, what is it and have I met it yet?

— Does my plan limit how many sessions per calendar year I can have? If so, what is the limit?

— Do I need written approval from my primary care physician in order for services to be covered?

Payment

I accept cash, check and all major credit cards as forms of payment. I also accept payment directly through my electronic records management system.

Cancellation Policy

If you are unable to attend a session, please make sure you cancel at least 24 hours beforehand. Otherwise, you may be charged for the full rate of the session.

Any Other Questions

Please contact me for any additional questions you may have. I look forward to hearing from you!