No Surprises Act - I am required to provide this!
This document describes your protections against unexpected medical bills.
It also asks if you’d like to give up those protections and pay more for out-of-network care.
IMPORTANT: You aren’t required to sign this form and shouldn’t sign it if you didn’t have a choice of health care provider before scheduling care.
You can choose to get care from a provider or facility in your health plan’s network, which may cost you less, then seeing an out of network provider.
You’re getting this notice because this provider, Trinity Wellness Group, LLC, IS NOT in your health plan’s network and is considered out-of-network. This means the provider or facility doesn’t have an agreement with your plan to provide services. Getting care from this provider or facility will likely cost you more.
If your insurance plan covers the item or service you’re getting, federal law protects you from higher bills when:
Ask your health care provider if you’re not sure if these protections apply to you.
If you sign this form, be aware that you may pay more because:
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Therapy is necessary for people who have a mental health condition, have symptoms, & need treatment. Your reaction to a betrayal is not necessarily a mental health condition that needs therapy. I am Professional Coach & a Licensed Therapist, I offer both services, I just can't be BOTH to you. I can be your therapist OR your coach. If we start in Coaching, & you need therapy, I would need to refer you to a therapist for treatment. If we start in therapy, we need to stay in therapy until treatment goals are met. Coaching is less formal with no diagnoses, not treatment plan. Still unsure?