In accordance with House Bill 4224 and Texas Health and Safety Code Section 181.105, Clear Head Counseling PLLC provides the following information to assist clients and members of the public with requesting access to health care records, contacting the state licensing authority, and filing a consumer complaint. .
Clients have the right to request access to their health care records.
To request your records:
1. Submit a written request by email. Please click here to obtain the form to be submitted.
2. Include your full name, date of birth, and the specific records you are requesting.
3. Requests may be subject to identity verification and applicable fees as permitted by law.
4. Records will be provided within the timeframe required by Texas law.
If you have questions about requesting records, please contact the practice directly using the contact information listed on this website.
If records are requested on behalf of another individual, documentation verifying legal authority is required. Examples include guardianship documentation or medical power of attorney.
Identity verification may be required to protect client privacy and confidentiality in accordance with applicable state and federal laws.
If you believe your rights have been violated or you wish to file a consumer complaint, you may contact the Office of the Texas Attorney General’s Consumer Protection Division.
You can file a complaint online at:https://www.texasattorneygeneral.gov/consumer-protection/file-consumer-complaint
This process is independent of the practice and allows consumers to raise concerns related to services provided in Texas.
These disclosures are provided in accordance with Texas House Bill 4224 and Texas Health & Safety Code §181.105.
If you would like to contact the Texas Behavioral Health Executive Council (BHEC), which oversees behavioral health licensing boards in Texas, you may do so using the information below:
Texas Behavioral Health Executive Council
Website: https://www.bhec.texas.gov
Contact Page: https://www.bhec.texas.gov/contact-us
The Council can provide information about licensure, regulations, and the complaint process.
We provide a highly-specialized, high-quality, trauma-focusedcounseling experience at affordable rates compared to other providers because we understand that counseling can be a necessary, but also an unexpected, investment.
Since we believe that people invest in what they value and feel is important to them, it is important to us that everyone should have the right to access high-quality services. We are motivated, highly trained, and strive to stay up-to-date on the latest techniques and interventions to help you and your child heal from their trauma experience.
*Fees are due at the time service by cash, card, or check*
To avoid a late cancellation fee, we ask that you please provide us with a 24-hour notice. Please refer to our Cancellation and No-Show Policy by clicking HERE for additional information. All clients are required to provide credit/debit card information, which will remain on file and will not be charged without client knowledge.
Good Faith Estimate (GFE)
The No Surprises Act went into effect January 1, 2022 which requires us to provide a Good Faith Estimate of the costs of care.
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.
We will give you a Good Faith Estimate in writing at least 3 business days before your scheduled session, or within 1 day in writing at least 1 business day before your scheduled session. 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.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
Make sure to save a copy or picture of your Good Faith Estimate.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-368-1019
Frequently Asked Questions:
Q: Can I use my medical insurance?
A: Not every provider is paneled with every insurance plan. If your provider is in-network with your specific insurance plan, we will verify your coverage and benefits to determine eligibility prior to providing services.
Additionally, If you have a insurance plan in which we are not in-network with, you may have out-of-network benefits that would allow you to be reimbursed. This allows you to choose the care you believe is best suited for you while still taking advantage of your insurance benefits. Oftentimes your insurance provider will reimburse you for a percentage of the session fee. Please contact your insurance company directly to get more information about the availability of out-of-network behavioral health benefits. I am happy to provide you with a receipt/monthly statement (superbill) and help you with the documentation to file with your insurance provider or flexible spending account (FSA/HSA).
Q: What are the benefits of private pay?
A: We are accepting new private pay clients at this time.
Insurance companies dictate your mental healthcare in various ways. For example, your insurance requires a diagnosis, regulates how many sessions are covered, and can deny your services completely. In addition, insurance companies have full access to client medical records, including mental healthcare, because they are the payor. Another inherent benefit of no insurance is that you may receive as many counseling sessions as needed for your child and family.
