No Surprises Act Disclosure Notice

Your Rights and Protections Against Surprise Medical Bills

As of January 1, 2022, under the federal No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical and mental health care will cost.

Right to a Good Faith Estimate

If you are uninsured or not using insurance for your services, you are entitled to receive a Good Faith Estimate of the expected charges for psychotherapy services.

> You have the right to receive this estimate in writing at least 1 business day before your first scheduled session.

> You may also request a Good Faith Estimate at any time, and one will be provided within 3 business days.

What is Included in a Good Faith Estimate?

Your estimate will include:

> The total expected cost of services, including session fees and frequency based on the treatment plan discussed.

> Any applicable administrative or service fees (if any).

You Have the Right to Dispute a Bill

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the U.S. Department of Health and Human Services.

> You must start the dispute process within 120 calendar days of receiving the bill.

> There is a $25 fee to use the dispute resolution process.

To Learn More

For more information about your rights under the No Surprises Act or how to dispute a bill, visit: www.cms.gov/nosurprises or call: 1-800-985-3059

Behlmann Counseling & Education, LLC is committed to transparency and ethical billing practices.

Contact Information

If you have any questions or concerns about fees, estimates, or your rights, please reach out to Behlmann Counseling & Education:

Email: info@behlmanncounseling.com
Phone: 512-222-8587
Website: www.behlmanncounseling.com