Notice to Consumers

Good Faith Estimate (No Surprises Act)

You have the right to receive a "Good Faith Estimate" explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.

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 or call (800) 985-3059.

Texas HB 4224

Texas House Bill 4224 requires mental health professionals in Texas to provide clients with certain disclosures about their practice, including their qualifications, the nature of therapy, and client rights.

As a Licensed Clinical Social Worker (LCSW), Micah Bolden is licensed by the Texas State Board of Social Worker Examiners. You have the right to:

• Be informed of your therapist's qualifications, including education, training, and experience.
• Receive information about the methods of therapy, the techniques used, and the duration of therapy (if known).
• End therapy at any time.
• Know if your therapist plans to use experimental treatments and to refuse such treatments.
• Report complaints about your therapist's conduct to the Texas State Board of Social Worker Examiners.
• Receive a copy of your records.
• Be informed of the limits of confidentiality.

If you have concerns about your therapist's conduct, you may contact the Texas Behavioral Health Executive Council at www.bhec.texas.gov or call (512) 305-7700.