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Insurance and

 Financial Responsibilities

Client 4

Health Insurance Plans

I am an in-network provider with:

  • Aetna

  • Cigna/Evernorth

  • UnitedHealthcare/Oxford

  • Husky

Your financial responsibility will be dependent on your insurance plan and benefits.

If I am out-of-network with your provider, I am able to provide you a superbill for you to send to your insurance company.

Client 1

Out-Of-Pocket, Fee For Service

As an alternative to using insurance, I am able to provide services at $175.00 for an intake session, and $150.00 per weekly session.

Client 7

Additional Services

Additional services outside of the planned weekly session will be charged accordingly, and with the client's agreement. This can include phone calls, filling out paperwork, etc.

Client 8

Contact Your Provider

Please always contact your insurance provider to check your health insurance benefits for accurate financial responsibilities.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services, including therapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. You can also 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. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.

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