For New Clients
Intake paperwork will be provided via your secure patient portal account. There, you can complete and securely e-sign and upload these documents, as well as upload a credit or HSA card for session or copay payments.
Intake paperwork will be provided via your secure patient portal account. There, you can complete and securely e-sign and upload these documents, as well as upload a credit or HSA card for session or copay payments.
Federal law requires me to provide you with a copy of the HIPAA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information. Please read these notices and sign the PHI Agreement via the patient portal before our first appointment.
Payment
I accept payment by cash, check, or credit card at the time of service.
Session Fees
Individual Therapy & Career Counseling
$150 for 50 minutes
$175 for 75 minutes
Couples Therapy
$150 for 50 minutes
$175 for 75 minutes (required for first session)
I have a limited number of sliding scale and pro bono slots. If my fee is a concern, please discuss it with me. If I am unable to accommodate your financial situation, I will provide you with referrals.
Insurance
I am an in-network provider for Aetna and UnitedHealthCare. If you choose to use one of these insurances, I will file the claims for you and our sessions will be 53 minutes long. If you wish to file for out-of-network reimbursement, I will give you a receipt for my services with the information the insurers need to pay you back if allowed by your contract. This information will include standard diagnostic and procedure codes, the times we met, my charges, and your payments.
Lateness & Cancellations
I consider our meetings very important and make them a priority over other activities, and I ask you to do the same. An appointment is a commitment to our work. A cancelled appointment slows our progress, so please try not to miss sessions if you can possibly help it. Your session time is reserved for you. If I am ever unable to start on time, I ask your understanding and promise that you will receive the full time agreed to or be charged proportionately. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours.
I am rarely able to fill a cancelled session, so you will be charged the full fee for sessions cancelled with less than 24 hours’ notice, for other than the most serious reasons.
I accept payment by cash, check, or credit card at the time of service.
Session Fees
Individual Therapy & Career Counseling
$150 for 50 minutes
$175 for 75 minutes
Couples Therapy
$150 for 50 minutes
$175 for 75 minutes (required for first session)
I have a limited number of sliding scale and pro bono slots. If my fee is a concern, please discuss it with me. If I am unable to accommodate your financial situation, I will provide you with referrals.
Insurance
I am an in-network provider for Aetna and UnitedHealthCare. If you choose to use one of these insurances, I will file the claims for you and our sessions will be 53 minutes long. If you wish to file for out-of-network reimbursement, I will give you a receipt for my services with the information the insurers need to pay you back if allowed by your contract. This information will include standard diagnostic and procedure codes, the times we met, my charges, and your payments.
Lateness & Cancellations
I consider our meetings very important and make them a priority over other activities, and I ask you to do the same. An appointment is a commitment to our work. A cancelled appointment slows our progress, so please try not to miss sessions if you can possibly help it. Your session time is reserved for you. If I am ever unable to start on time, I ask your understanding and promise that you will receive the full time agreed to or be charged proportionately. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours.
I am rarely able to fill a cancelled session, so you will be charged the full fee for sessions cancelled with less than 24 hours’ notice, for other than the most serious reasons.
No Surprises Act
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
OMB Control Number: 0938-1401
Expiration Date: 03/31/2022
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Additionally, Colorado protects patients covered by managed care plans from surprise medical bills for health care services provided at an in-network facility by an out-of-network provider. Colorado also protects patients from surprise medical bills for emergency services, even if the emergency services are out-of-network or provided by an out-of-network provider. Colorado law requires that patients pay only their in-network cost sharing amounts.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
Additionally, Colorado law does not protect patients from surprise medical bills when the patient intentionally uses an out-of-network provider.
When balance billing isn’t allowed, you also have the following protections:
If you believe you’ve been wrongly billed, you may contact:
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
OMB Control Number: 0938-1401
Expiration Date: 03/31/2022
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Additionally, Colorado protects patients covered by managed care plans from surprise medical bills for health care services provided at an in-network facility by an out-of-network provider. Colorado also protects patients from surprise medical bills for emergency services, even if the emergency services are out-of-network or provided by an out-of-network provider. Colorado law requires that patients pay only their in-network cost sharing amounts.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
Additionally, Colorado law does not protect patients from surprise medical bills when the patient intentionally uses an out-of-network provider.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact:
- The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
- If you believe you’ve been wrongly billed, contact the Colorado Department of Regulatory Agencies, Division of Insurance, Consumer Services Division at 303-894-7490 or DORA_Insurance@state.co.us.
- Visit “Out-of-Network Health Care Provider Reimbursement” for more information about your rights under Colorado law.