Now Accepting New Clients!
Now Accepting New Clients!
We currently accept Aetna, Optum, ComPsych, and Tricare insurances.
We will provide you with a billing statement to submit for the utilization of your out-of-network benefits for insurances in which we are not in-network.
No shows and late cancellations (less than 24 hours) incur a $50 fee.
If you are billed for more than this Good Faith Estimate, you may have the right to dispute the bill.**
You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate.
You can ask them 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 (about 4 months) of the date on the original bill.
If you dispute your bill, the provider or facility cannot move the bill for the disputed item or service into collection or threaten to do so,
or if the bill has already been moved into collection, the provider or facility has to cease collection efforts.
The provider or facility must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded.
The provider or facility cannot take or threaten to take any retributive action against you for disputing your bill.
There is a $25 fee to use the dispute process.
If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
Please reference Intake Documents for Good Faith Estimates and costs of services that are reasonably expected for your healthcare needs at time of that service. The estimates are based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, and your bill is $400 or more for any provider or facility than your Good Faith Estimate for that provider or facility, federal law allows you to dispute the bill.
**To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059. -Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount. **This Good Faith Estimate is not a contract. It does not oblige you to accept the services listed.
Copyright © 2024 Garden Path Counseling - All Rights Reserved.
Powered by GoDaddy
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.