Current clients can access the portal HERE.

In the case you are unable to attend a session, please make sure to contact your therapist at least 72 hours beforehand. There will be a charge for the full rate of the session if cancellation happens within 72 hours of your session. Additionally arriving 15 minutes or more to an appointment is considered a no-show and the late cancellation fee applies. (1-3 clock hours).

The cancellation policy for intensives is different. Booking Intensives (4+ hours) requires a 50% upfront, non-refundable deposit. The cancellation policy for the remainder is 7 calendar days or more, otherwise full payment is expected.

Cancellations with less notice, or missed appointments, will incur the full fee. Please message via the portal, email, or call to cancel.

I offer a fee for service counseling, coaching, and consulting practice. I accept FSA/HSA, debit and credit cards.

$300.00 | Individual/EMDR Sessions (50 minutes)

$150.00 | EMDR Group (50 minutes)

$400.00 | Relationship/Sex Therapy Intake (50 minutes)

$350.00 | Relationship/Sex Therapy (50 minutes)

$4000.00 | Full Day Custom Intensive (7 hours; included working lunch)

$2000.00 | Half Day Custom Intensive (4 hours)

$400.00 | Coaching (50 minutes)

An onsite/travel fees are added if applicable. They will be discussed and agreeed upon in writing prior to rendering services.

I am working towards offering third party payment options for custom intensives. Reach out to inquire.

I do not participate as a provider with any insurance plans and am a fee-for-service, or private pay, practice. This means clients pay the full fee for services at the time the services are rendered. Payments will be made with the card on file.

I want to focus on client care and avoid processes that intrude on client confidentiality or needs. I have considered and thoughtfully explored the advantages of offering fee-for-service counseling. In many instances, utilizing insurance removes power from the client and provider to decide on appropriate individualized treatment plans and at times, requires inappropriate use of diagnoses, codes, and labels. Using insurance for many of my services would hinder my ability to collaborate with clients and others. By not participating with insurance plans, I am not obligated to follow insurance guidelines that require me to provide information or follow guidelines that may not be helpful in client treatment and care. Being out of network allows me to provide quality care that is confidential with and customized to your unique goals.

Many clients use their medical reimbursement or HSA/FSA cards for their treatment.

I can always provide you with a detailed receipt for services. In some instances, I can provide you with a specific billing statement, a super bill, that you may use to file an out of network claim with your insurance company. I may or may not include all the components any given insurance company may require for reimbursement. It is up to my discretion whether to provide such a statement or details.

Key questions to ask your insurance provider about reimbursement forservices include:

• Do I have out of network coverage for behavioral healthcare?

• What is my out of network deductible for behavioral healthcare?

• Is there a limit to how many visits I can have with my provider?

• What will I be reimbursed per session based on the CPT billing codes (see below)?

• Is a diagnosis required for reimbursement?

• For couples/relationship counseling there a specific party that needs to be listed as primary?

Common CPT billing codes for counseling at my practice:

• 90791 Initial Evaluation (60 minute session)

• 90834 Individual Therapy (45-50 minute session)

• 90847/90846 Family/Relationship Therapy (50 minute session)

I do not work with medicare or medicaid.

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

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services.

• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.

• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit

www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

PRIVACY ACT STATEMENT: CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity’s compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.

Texas law requires that requests for mental health records be in writing. In order to obtain your records, or your minor’s records from your provider, you must contact your provider directly. I am the guardian for client records. You can contact me directly via email to request records.

The following may be a part of the process:

• Complete a written request of the records. Please be sure to include the records you want, and the name, address, and/or e-mail address of the intended recipient. I may request a phone call in order to ensure clarity about what is being requested and format.

• If the records are to be used in litigation, please include case information, such as the cause number, title, and court where the case is pending.

• If you need a Business Records Affidavit, please let us know in your request for records. There is a $15 charge for providing a Business Records Affidavit. No Affidavit will be provided unless the fee is paid in advance.

• I have the right to charge for providing records and I accept credit cards.

• If you are requesting a copy of couples counseling records, family counseling records, or records for a person who is not yourself or your child, state and federal law require that you provide either a Court Order or an Authorization signed by the person (or parent of the person) whose records you are requesting. 45 C.F.R. §164.512(e); Texas Health & Safety Code §611.004, §611.0045, §611.008.

A subpoena alone is not sufficient to compel the disclosure of confidential counseling and billing records or “Protected Health Information” (PHI) under the Health Insurance Privacy and Portability Act Privacy Rule (HIPAA), 45 C.F.R. Chapter 164.

For medical/hospital/mental health records or information that are requested or subpoenaed in litigation (including court testimony), HIPAA allows a covered entity (such as INSERT YOUR NAME OR NAME OF YOUR PRACTICE) to disclose PHI in the course of any judicial or administrative proceeding as follows:

(1) In response to an order of a court or administrative tribunal; or

(2) Where the individual (or parent) is a party to the proceeding, he/she knows that the request for his/her PHI has been made, and does not object.

45 C.F.R. §164.512(e). An Authorization from the individual or parent is the kind of document that will satisfy the second option.

NOTE: If the client or parent has indicated that they do not want their records released, a “Statement of Assurance” will not be accepted, and an Authorization or Court Order will be required.

While I would like the opportunity to resolve concerns if you have any, you have a right to have your complaints heard and resolved in a timely manner. If I cannot work things out to your satisfaction, you may file a complaint with my licensing board:

Texas Behavioral Health Executive Council
1801 Congress Avenue, Suite 7.300
Austin, TX 78701
Telephone: 1-800-821-3205

Link to Complaint Form: http://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf.

If you have a complaint concerning the HIPAA Privacy Regulations, you may contact the U. S. Department of Health and Human Services, Office for Civil Rights, at: OCRMail@hhs.gov.

If you believe that you have a Consumer Complaint regarding the privacy and security of your health information, you may contact the Texas Office of the Attorney General and file a consumer complaint by clicking this link:
https://www.texasattorneygeneral.gov/consumer-protection/health-care/patient-privacycription

To file a complaint for telehealth services for Florida clients:
https://complaint-portal.mqa.flhealthsource.gov/person

To file a complaint for telehealth services for Louisiana clients:
https://www.lpcboard.org/page/75