I am legally required to tell you some things…
Good Faith Estimate
Under section 2799B-6 of the Public Health Services Act (No Surprises Act), healthcare providers and healthcare facilities are required to inform individuals who are not enrolled in a plan of coverage or a federal healthcare program, or not seeking to file a claim with their plan of coverage, 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, healthcare providers need to give patients who don’t have insurance or are not using insurance an estimate of the bill for medical items and services.
To figure your cost for services rendered, simply take your cost per session and multiply it by the number of sessions. You can multiply by 4.33 to reach your monthly rate, if you are seen weekly. You can multiply by 52 to get your yearly rate.
As a reminder, no-shows (either not showing up for your session at all, or sessions in which you are more than 10 minutes late that I am then forced to cancel), and late cancellations (within 24 hours of your appointment time) are charged at the full session rate.
The No Surprises Act also requires that I offer a diagnosis to my clients. I work with the issues that each client presents to me. Since I do not make a habit of diagnosing, my clients, my focus of treatment is Z03.89, no diagnosis or condition. This may change if, in the course of our work together, we decide that a different diagnosis is applicable and appropriate. Insurance companies require me to give a diagnosis, in order to cover treatment. We can discuss this individually.
This document does not change anything about our sessions, I am simply required to make sure that you have received it. Please let me know if you have any questions about this Good Faith Estimate.
How to make a complaint to the LPC board
NOTICE TO CLIENTS
The Texas Behavioral Health Executive Council investigates and prosecutes professional
misconduct committed by marriage and family therapists, professional counselors, psychologists,
psychological associates, social workers, and licensed specialists in school psychology.
Although not every complaint against or dispute with a licensee involves professional
misconduct, the Executive Council will provide you with information about how to file a
complaint.
Texas Behavioral Health Executive Council
George H.W. Bush State Office Building
1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
Main Line (512) 305-7700
Investigations/Complaints 24-hour, toll-free system (800) 821-3205
My License
I have been licensed in the state of Texas since 2018, and my license number is 79555.