
Good Faith
Estimate Statement
Notice to clients and prospective clients:
AHA! Studio for Integrated Therapies LLC is an out of network provider. Services are payable by you in full at the time of service and our office will send a quarterly statement for all services provided during each 3 month period. Statements will be issued by the 15th of April (Q1), July (Q2), October (Q3), and January (Q4). Statements will have all necessary codes for you to submit to your insurance carrier for out of network services.
All CPT coded billable services provided by our licensed clinicians can be submitted for reimbursement. Please note, AHA! Studio LLC can not assure your insurance will reimburse you, however we will do our best to provide you with all of the coding and information needed for a reimbursement determination.
If you would like to seek reimbursement from your health insurance, please call your insurance company before beginning services at AHA! to inquire about the following:
Out of network coverage
Your plan's deductible for out of network services provided by a PA-licensed therapist
Rate of expected reimbursement once your annual deductible is met
Please note: Annual deductibles typically reset on the first day of each new year.
As a self-pay patient, you are entitled to a Good Faith Estimate which outlines the potential costs associated with your evaluation and treatment in our office.
Under the law, out of network health care providers need to give clients an estimate of the expected charges for medical and mental health services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services.
You can ask your health care provider 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, or how to dispute a bill, see your Estimate, or visit http://www.cms.gov/nosurprises .