No Surprises act
Your Right to a Good Faith Estimate
Under Section 2799B-6 of the Public Health Service Act, I am required to provide a good faith estimate of expected charges for items and services to individuals who are not enrolled in an insurance plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage. The information in the good faith estimate is only an estimate. The good faith estimate is not a contract and does not require you to obtain the services from us.
Prior to an initial diagnostic evaluation, financial estimates are difficult to calculate. Generally, most patients requiring psychotherapy services with an accompanying ICD-10/DSM diagnosis should plan for weekly therapy session at my quoted rate. I will make this rate available to you in an initial phone call/email when scheduling and in your intake packet should you decide to move forward with treatment. Following the initial diagnostic evaluation, given your clinical presentation and level of distress, the frequency of sessions could increase of decrease from the original estimate.
If you are billed more than this good faith estimate, you have a right to dispute the bill. To do so, please contact me to let me know that the billed charges are higher than the good faith estimate. You can ask me to update the bill to match the good faith estimate, ask to negotiate the bill or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with Rachel Bacon, LCPC, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-877-696-6775.