Therapy

Private Pay Rates

In-Network Insurance

Headway will verify your benefits instantly prior to your first visit, providing full clarity on co-pays and deductibles. *Let me set you up on Headway so you aren't charged a setup fee.

$150

TENNESSEE PLANS:
Aetna
Anthem EAP:
Bank of America (12 session limit)
Commonwealth of Virginia (4 session limit)
The Local Choice (4 session limit)
Line of Duty Act (4 session limit)
Ascension (SmartHealth)
Blue Cross Blue Shield of TN
Carelon
Cigna
Curative
Independence Blue Cross PA
Oscar (Optum)
Oxford (Optum)
Quest
United Healthcare (Optum)

Payment is collected through Headway.

If your insurance plan includes out-of-network mental health benefits, you may be eligible for partial reimbursement from your insurance company. I can provide a superbill for you to submit to your insurance for possible reimbursement.

Because every insurance plan is different, I recommend contacting your insurance company directly to confirm your out-of-network benefits. Payment of the full session fee is due at the time of service, and reimbursement is determined by your insurance company.

Questions to ask your insurance company:

• Do I have out-of-network benefits for outpatient mental health services?

• Do I have an out-of-network deductible, and how much of it has been met?

• What percentage will my plan reimburse after my deductible is met?

• How do I submit a superbill for reimbursement?

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 healthcare 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

NOTICE TO CLIENTS

The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors. You may contact the California board online at www.bbs.ca.gov, or by calling (916) 574-7830. For Texas clients, contact Texas Behavioral Health Executive Council (BHEC) website to find and download the complaint form, or contact BHEC to request one. For Tennessee clients, contact go to TN.gov's Health Professional Boards page: Visit tn.gov/health/health-program-areas/health-professional-boards/report-a-concern.html.

NOTICE OF RIGHT TO ACCESS MEDICAL RECORDS

Right to Inspect and Receive Copies
You have the right to inspect and obtain a copy of your health information records for as long as this entity maintains these records. Under state and federal law, a "designated record set" typically includes your clinical progress notes, treatment plans, billing statements, and any other information used to make decisions about your care. Requesting Your Records: To exercise this right, you must submit your request in writing to this office. Your written request should include your full name, date of birth, and the specific dates of service or types of records you are requesting. Fees for Copies: We reserve the right to charge a reasonable, cost-based fee for the labor and supplies associated with copying, mailing, or preparing an electronic summary of your records. We will provide you with an estimate of these fees prior to processing your request. Timeframe for Response: Upon receipt of your written request, we will provide access to or copies of your records within the timeframes mandated by law (generally within 15 days for a request to inspect or 30 days for a request for copies). Contact Information: To submit a written request or for questions regarding your medical records, please contact: Lavon Head, LMFT, 1650 Murfreesboro Rd, Ste 216, Franklin, TN 37067 (559) 816-3178 email: lavonheadmft@gmail.com