FEES & POLICIES

Fees

This is a fee-for-service psychotherapy practice. I do not accept payment directly from or bill through health insurance plans. Some insurance companies may offer reimbursement according to the guidelines they have established for out-of-network providers. Upon request, I will supply you with a superbill, which you can submit to your insurance company for reimbursement. Please note that not all insurance companies reimburse for out-of-network providers.
You should be aware that out-of-network reimbursement is often contingent on receiving a clinical diagnosis and certain diagnoses may not qualify. I do not accept responsibility for collecting payment from your insurance company and cannot guarantee that you will be reimbursed or that you will qualify for a reimbursable diagnosis. Please contact your insurance provider to find out if you have out-of-network coverage and bring any necessary forms to your initial appointment. I understand that psychotherapy requires investments of time, money, and emotional and mental energy.
The benefits of paying out-of-pocket for psychotherapy services include the ability to develop tailored treatment goals and determine the appropriate duration and frequency of sessions without having to worry about the possible limitations that third party payers may introduce.
Please contact me for more information about fees.

Policies

You are responsible for paying at the time of service unless prior arrangements have been made. Debit/credit cards and HSA cards are acceptable forms of payment. Card payments are processed through an electronic medical record program (i.e., TherapyNotes). If your account balance has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I reserve the right to use legal means to secure the payment. This may involve hiring a collection agency or going through a small claims court. You are responsible for the costs of any action necessary to collect your portion of the fee due, including court and attorney fees that might accrue. You will receive appropriate notice of efforts to obtain this debt. 

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

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.For questions or more information about your right to a Good Faith Estimate, visit http://www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.

PRIVACY ACT STATEMENT: CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity’s compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.

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