• Once you submit your information, you’ll receive a link to complete the intake forms through a secure platform called Simple Practice.

• Once the intake forms have been submitted, I’ll contact you to schedule a new client intake appointment, which is a time for us to discuss your concern(s), and biopsychosocial history.

• Based on your needs and my perception about my ability to be helpful, we will either schedule another appointment or I will provide a referral to another provider.

I accept Blue Cross Blue Shield and encourage you to verify your mental health coverage.

Payments can be made via Health Savings Account (HSA), credit card, cash, or check. All clients need to have a valid credit or debit card on file.

Under the “No Surprises Act” effective 1/1/2022:

• You have the right to receive a “Good Faith Estimate” explaining how much your medical and health care will cost.

• Health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including speech therapy services.

•You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

• 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.

New Surprise Billing Requirements and Prohibitions

• No balance billing for out-of-network emergency services

• No balance billing for non-emergency services by out-of-network providers during patient visits to certain in-network healthcare facilities, unless notice and consent requirements are met for certain items and services.

• Providers and healthcare facilities must publicly disclose patient protections against balance billing

• No balance billing for covered air ambulance services by out-of-network air ambulance providers

• In instances where balance billing is prohibited, cost sharing for insured patients is limited to in-network levels or amounts

• Providers must give a good faith estimate of expected charges to uninsured and self-pay patients at least 3 business days before a scheduled service, or upon request

• Plans and issuers and providers and facilities must ensure continuity of care when a provider’s network status changes in certain circumstances

• Plans and issuers and providers and facilities must implement certain measures to improve the accuracy of provider directory information

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, call (720) 845-6600.