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Kaleidoscope Therapy and Wellness PLLC

    Contact Lindsey
    • Home
    • About
    • Services 
      • Counseling
      • Birth Doula
      • Client Forms
    • Resources 
      • Pregnancy & Postpartum
      • Other Helpful Resources
      • Why Kaleidoscope?
    • Contact
    • …  
      • Home
      • About
      • Services 
        • Counseling
        • Birth Doula
        • Client Forms
      • Resources 
        • Pregnancy & Postpartum
        • Other Helpful Resources
        • Why Kaleidoscope?
      • Contact
    broken image
    broken image

    Kaleidoscope Therapy and Wellness PLLC

      Contact Lindsey
      • Home
      • About
      • Services 
        • Counseling
        • Birth Doula
        • Client Forms
      • Resources 
        • Pregnancy & Postpartum
        • Other Helpful Resources
        • Why Kaleidoscope?
      • Contact
      • …  
        • Home
        • About
        • Services 
          • Counseling
          • Birth Doula
          • Client Forms
        • Resources 
          • Pregnancy & Postpartum
          • Other Helpful Resources
          • Why Kaleidoscope?
        • Contact
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      broken image
      • Client Forms

        Practice Policies, Forms, and Good Faith Estimates

      • Client Information & Consent to Treatment
        HIPAA Notice of Privacy Practices
        Telepractice Policy
        Authorization for Release of Information

        The No Surprises Act and Good Faith Estimate Requests

        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 provide patients who don't have insurance or who are not using insurance may receive 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 of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or dial 800-985-3059.

         

        For a Good Faith Estimate of counseling services with Lindsey, please submit the request form below:

         

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