Other Information

• Payment Method(s): Payment is due at the start of each session. I accept major credit cards for payment. I will provide a Good Faith Estimate (https://www.cms.gov/nosurprises) at least one business day before services begin, providing you with an estimated cost for services based on an approximate number of sessions.

• Why Self-Pay? Self-pay services can be more appealing to some individuals for the following reasons:

  • Improved privacy of personal health information, including diagnosis. Records are maintained between you and your provider, under the protection and limitations of confidentiality.

  • Greater flexibility. You can choose a provider whose style and approach seems like a good fit for you without having to worry about who is in-network.

  • Access to specialists. You can choose providers with specialty areas that may not be covered by your insurance plan.

  • Greater privacy of personal health information, including diagnosis.

  • Personalized care. You and your provider can determine the number of sessions and frequency of appointments without third parties dictating your access to treatment.

• Out-of-Network Benefits: Although I do not accept insurance, you may request reimbursement for out-of-network services. I encourage you to contact your insurance carrier to become more familiar with your out-of-network benefits. If you’d like to use your benefits, I will provide a detailed receipt (a “super bill”), at your request, that can be submitted to your insurance company.

• Telehealth Services: Convenient telehealth services may be available, if determined to be an appropriate form of treatment for your situation and your goals. Clients must be residents of the State of Ohio and in the state at the time of the appointment.

• No Surprises Act

  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.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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.