Insurance, Cancellation Policy and Good Faith Estimate

I do not accept insurance. I am an out-of-network provider, which means that the full fee for my service is due at the time of your appointment. If you’d like, you may decide to submit claims to your insurance company. I will provide you with proof of payment (super bill) to submit to your insurance company for reimbursement.

Before submitting to your insurance, please consider the following possibilities:

You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
To use insurance mental health benefits, a mental health/behavioral health diagnostic code is required.
Insurance companies may require access to your mental health record to reimburse your payment.
Access to your confidential mental records by insurance could impact future employment and health/life insurance premiums, and court/legal issues.
If you pay out of pocket, submitting diagnoses to insurance companies is not necessary.
Insurance companies may not reimburse the full cost of services, so check with your insurance provider first.
You are responsible for completing all required insurance forms for reimbursement.
All payments are due at the time of service.

Cancellation Policy

If you are unable to attend a session, please make sure you cancel at least 48 hours beforehand. Otherwise, you will be charged for the full rate of the session.

Public Health Service Act Information: Good Faith Estimate

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

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

This form will be provided to all private pay clients at the beginning of therapeutic services.