Good Faith Estimate Notice

Under federal law, you have the right to receive a Good Faith Estimate explaining how much your health care will cost before you receive services.

  • If you are not using insurance or are self-pay, you can request a Good Faith Estimate for the total expected cost of your services, including psychotherapy, evaluation, and related items or services.

  • You may ask for this estimate before scheduling or at any time during treatment.

  • If you receive a bill that is $400 or more above your Good Faith Estimate, you may be able to dispute the bill.

  • Keep a copy of your Good Faith Estimate for your records.

For more information about your right to a Good Faith Estimate under federal law, visit: www.cms.gov/nosurprises or call 1-800-985-3059.

Notice to Consumers – Texas Law

In accordance with Texas House Bill 4224 and Texas Health & Safety Code §181.105, you are entitled to the following information:

Access to Mental Health Records
You have the right to request access to or copies of your mental health records maintained by this practice.
Please note:

  • Requests must be submitted in writing.

  • Requests for copies of records may be subject to reasonable fees, as permitted by Texas and federal law.

  • Any applicable fees will be communicated to you in advance of fulfilling the request.

  • No fees are charged for simply reviewing records in person.

  • Records will be released in accordance with applicable privacy laws and after required authorizations are completed.

To request records, please contact your clinician directly or contact@empowered-wellness-counseling.com

Professional Licensing Information

This practice is regulated by the Texas Behavioral Health Executive Council (BHEC).

You may contact BHEC with questions about professional licensure or standards of care:
https://bhec.texas.gov
(512) 305-7700 or (800) 821-3205

Filing a Consumer Complaint

If you wish to file a complaint regarding mental health services in Texas, you may contact:

Texas Attorney General – Consumer Protection Division
https://www.texasattorneygeneral.gov/consumer-protection
(800) 621-0508

Questions or Additional Information

If you have any questions about your rights, records, or fees, please contact:

Empowered Wellness Counseling at contact@empowered-wellness-counseling.com