FEDERAL AND TEXAS REQUIRED NOTICES
The following information is provided in compliance with the federal No Surprises Act and the Texas Health & Safety Code §181.105 (House Bill 4224). Together, they requires certain health care providers to provide clients with a cost of services estimate, to post instructions for requesting records, and to provide instructions for filing consumer complaints.
GOOD FAITH ESTIMATE (NO SURPRISES ACT)
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under federal law, health care providers must provide clients who do not have insurance or who are not using insurance with an estimate of the expected charges for services before those services are provided.
Because the length of therapy varies depending on each person’s needs and goals, the total cost of services cannot always be determined in advance. Your Good Faith Estimate will include a fee schedule for services typically provided by your therapist. We will review your treatment plan with you regularly and discuss the anticipated number of sessions.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
Please save a copy or photo of your Good Faith Estimate for your records.
For more information about your rights under the No Surprises Act, visit:
https://www.cms.gov/nosurprises
REQUESTING YOUR HEALTH CARE RECORDS
You have the right to request access to or copies of your health care records maintained by this practice.
To request your records, please submit a written request to our office. Your request should include your full name, date of birth, contact information, and a description of the records requested. Requests are processed in accordance with applicable state and federal laws, including HIPAA and Texas regulations. Certain limitations may apply to mental health records as permitted by law.
LICENSING AND REGULATORY INFORMATION
Licensed Professional Counselors in Texas are regulated by the Texas Behavioral Health Executive Council.
Texas Behavioral Health Executive Council
Website: https://bhec.texas.gov
Contact page: https://bhec.texas.gov/contact-us/
Phone: (512) 305-7700 or (800) 821-3205
Mailing Address:
1801 Congress Ave., Ste. 7.300
Austin, TX 78701
FILING A CONSUMER COMPLAINT
If you wish to file a consumer complaint regarding services, you may contact the Texas Office of the Attorney General Consumer Protection Division.
File a complaint online:
https://www.texasattorneygeneral.gov/consumer-protection/file-consumer-complaint
Consumer Protection Hotline:
(800) 621-0508
Mailing Address:
Office of the Attorney General
Consumer Protection Division
P.O. Box 12548
Austin, TX 78711-2548