Lorenzo Teixeira, LPCC, RPT-S, NCC
(925) 403-1349 | firstname.lastname@example.org
Counseling for Children, Adolescents & Families
No Surprises Act
Notice to clients and prospective clients:
Under the new federal law (HR133, Title 45 Section 149.610), health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
It is always my intent to be as transparent as possible about my service fees and the services I provide. If you ever have any concerns or questions, please contact me at email@example.com.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your therapist, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, visit www.cms.gov/nosurprises.