Your rights under the federal No Surprises Act.

Document icon representing the Good Faith Estimate page for Austen LaBarge LCSW virtual telehealth therapy services in New York under the federal No Surprises Act

GOOD FAITH ESTIMATE

Information icon representing Good Faith Estimate details for Austen LaBarge LCSW virtual telehealth therapy services in New York under the federal No Surprises Act

WHAT IS A GOOD FAITH ESTIMATE?

Under the federal No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges before receiving healthcare services. This estimate shows the expected cost of items and services provided, and is given to you in advance of care when services are scheduled or upon request.

Person with checkmark icon indicating who qualifies to request a Good Faith Estimate from Austen LaBarge LCSW, virtual telehealth therapist in New York

WHO THIS APPLIES TO

If you are uninsured or plan to pay out of pocket, you may request a Good Faith Estimate at any time before your appointment. The estimate will include expected charges, provider information including NPI and TIN, and a statement noting that actual charges may differ from the estimate.

Warning triangle icon highlighting patient billing dispute rights under the No Surprises Act for Austen LaBarge LCSW virtual telehealth therapy services in New York

YOUR RIGHT TO DISPUTE

If your final bill is $400 or more above the Good Faith Estimate you received, you have the right to dispute the charge through the federal Patient-Provider Dispute Resolution process.

Dollar sign icon representing current out-of-pocket session rates for virtual telehealth therapy with Austen LaBarge LCSW in New York

CURRENT OUT-OF-POCKET RATES

Individual Session: $150

Couples & Family Session: $225

REQUEST A GOOD FAITH ESTIMATE

(315) 757-2248

Phone icon to call Austen LaBarge LCSW to request a Good Faith Estimate for virtual telehealth therapy services in New York at 315-757-2248

alabarge@austenlabargelcsw.com

Email icon to contact Austen LaBarge LCSW to request a Good Faith Estimate for virtual telehealth therapy services in New York at alabarge@austenlabargelcsw.com
SCHEDULE YOUR FREE CONSULTATION

This notice is provided in accordance with the No Surprises Act (Public Law 116-260). For more information, visit cms.gov/nosurprises.