Good Faith Estimate

The No Surprises Act of 2020 is intended to protect healthcare consumers from “surprise” medical bills incurred at larger healthcare facilities for services provided by out-of-network providers at these facilities. I am required to provide you with this “Good Faith Estimate” of the cost of our services.

Fees are clearly outlined in our Practice Agreement. However, with the course of mental illness and the response to treatment being variable, it’s difficult to predict the cost of our services with certainty, because appointments may need to become more frequent or less frequent, depending on the progress being made. As required by the No Surprises Act, we can offer estimations of what our services will cost you in the following hypothetical scenarios, extrapolated to a 12-month/52-week treatment period:

  • Initial Assessment + WEEKLY Individual Therapy (60 min): $6,575

  • Initial Assessment + BI-WEEKLY Individual Therapy (60 min): $3,450

  • Initial Assessment + WEEKLY Couples/Family Therapy (60 min): $10,400

  • Initial Assessment + BI-WEEKLY Couples/Family Therapy (60 min): $5,200

  • Initial Assessment + MONTHLY Individual Therapy (60 min):$1,700

  • Initial Assessment + MONTHLY Couples/Family Therapy (60 min):$2,600

 

Please understand that these estimates are our ‘best guess’ as to what treatment may cost, and carefully consider which of these services apply to you. The cost of “Between-appointment correspondences” such as phone calls or paperwork are not included because these are highly variable and often negligible or totally absent. This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of psychotherapy visits. The number of visits that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with your provider. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

 If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

You may contact us to let us know the billed charges are higher than the Good Faith Estimate. You can ask us to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). You have a right to initiate a dispute resolution process if the actual amount charged to you substantially exceeds the estimated charges stated in your Good Faith Estimate (which means $400 or more beyond the estimated charges). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. 

 

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. 

 

To learn more and get a form to start the process, go to www.cms.gov/nosurprises.

Privacy Policy

This privacy policy applies to the use of www.lagniappecounseling.com.  Your privacy is very important to me. Accordingly, I have developed this policy in order for you to understand how I collect, use, communicate and disclose and make use of personal information. The following outlines my privacy policy for counseling clients only.

GENERAL TERMS

Before or at the time of collecting personal information, I will identify the purposes for which information is being collected. I will only retain personal information as long as necessary for the fulfillment of those purposes.

I will collect and use personal information solely with the objective of fulfilling those purposes specified by me and for other compatible purposes, unless I obtain the consent of the individual concerned or as required by law (see below).  I will protect personal information by reasonable security safeguards, as well as unauthorized access, disclosure, copying, use or modification.

LINKS TO OTHER WEBSITES

I am not responsible for the practices employed by any websites or services linked to or from the site, including the information or content contained within them. Please remember that when you use a link to go from this site to another website or service, the policy does not apply to those third-party websites or services. Your browsing and interaction on any third-party website or service, including those that have a link on this website, are subject to that third party's own rules and policies. In addition, you agree that I am not responsible and do not have control over any third-parties that you authorize to access your information. If you are using a third-party website or service and you allow them to access your information, you do so at your own risk. Consequently, I strongly suggest that you review the privacy policy of every website you visit, whether or not they are linked to this site.

LEGAL DISCLAIMER

I reserve the right to disclose your personally identifiable information as required by law, when I believe that disclosure is necessary to protect our rights, and/or to comply with a judicial proceeding, court order or other legal process.

CHANGES TO OUR POLICY

Times change, as do privacy expectations.  I consider this a living document, and may modify or update this policy from time to time, so please review it periodically. I may provide you additional forms of notice of modifications or updates as appropriate under the circumstances, as a courtesy only. Your continued use of this site after any modification to this policy will constitute your acceptance of such modification.

Social Media Policy

This document outlines my office policies related to use of Social Media. Please read it to understand how I conduct myself on the Internet as a mental health professional and how you can expect me to respond to interactions that may occur between us on the Internet. Please discuss any questions or concerns you may have with me directly.

SEPARATE ACCOUNTS

Amanda Hembree, LP(C)C, CEAP holds separate and isolated accounts to be used for the sole purpose of professional matters regarding Lagniappe Counseling. These accounts are separate from any personal accounts held by Amanda Hembree as an individual.

EMAIL

Please use email to contact me for administrative reasons only (modifying appointments, billing information, etc.). Please do not email content related to our counseling sessions, unless otherwise discussed. Email communication is not completely secure or confidential. Any emails I receive from you and any responses I send to you become a part of your legal record.

TEXT

Please do not send text messages, unless otherwise agreed upon. I will not respond to texting. Any text message I receive from you becomes a part of your legal record. Traditional text messaging is not considered HIPAA compliant.

FRIENDING/FOLLOWING 

I will not follow any client on personal Twitter, Instagram, blogs, or other apps/websites. If there is content you wish to share from your online life, please bring it into our sessions where we can explore it together.

Image by Dan Nelson