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No Surprises Act  -  Information

Patients are entitled to be notified of the No Surprises Act (NSA), which protects patients from an unexpected bill (also called surprise or balance billing). This can happen when there is an emergency service or when you cannot control who is involved in your care at an in-network facility.  


I am an out-of-network provider, which means that I do not accept insurance or participate with any insurance providers.  Payment is due to me directly at the time of service.  Those who have insurance may wish to submit claims to their insurance company for some degree of reimbursement if their policy allows.  My fees for all services are on listed in my “Office Policies and Patient Services Agreement” document, which is posted on this website under the "Office Forms and Information" tab.  This document is also provided to each patient (or parent if patient is under 18 years old) prior to services beginning.  A signature of agreement to the fees and policies is required before treatment can commence.  Therefore, there is complete transparency regarding fees prior to, and during, treatment. 


Each patient has a right to decide how long they would like to participate in mental health care.  At the start of treatment and at points throughout, we will discuss the goals of treatment, the frequency of sessions, and the needed and/or desired length of treatment.  At any point you would like to discontinue treatment, I hope to discuss the best way to do so, but you are always free to stop immediately.

Prior to beginning treatment, you will complete a form that asks two questions in order to determine your needs under The No Surprises Act:

  1. To determine if you are considered an uninsured or self-pay individual as defined by the NSA, I must ask if you are enrolled in any of the following: Group health plan; Individual or group health insurance coverage offered by a health insurance issuer/company; Federal health care programs (incl. Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, TRICARE); Health benefits plan under a Federal Employees Health Benefits (FEHB) Program or if you are uninsured.

   2. If you are enrolled in one of these plans or programs, I need to know if you are planning to submit a claim for my services with such plan or           coverage.

If you have insurance and are planning to submit to your insurance company for reimbursement, then you do not need any further documentation related to the No Surprises Act legislation.  If you either do not have insurance or do but are not submitting a reimbursement claim to your insurance, then you will need “Good Faith Estimate” documentation from me regarding the services I provide.  I will provide you with this documentation once I have received the aforementioned information from you, and then will ask you to sign this documentation and return it to me for your record. 

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