The No Surprises Act (effective January 1, 2022) is a federal law that protects clients from unexpected medical bills, also known as “surprise billing” or “balance billing.”

You have the right to:

• Receive a Good Faith Estimate of expected charges before receiving services if you are uninsured or choosing not to use insurance.
• Be protected from surprise billing for emergency services or certain services provided by out-of-network providers at in-network facilities (not typically applicable to outpatient mental health care).
• Dispute charges that are significantly higher than your Good Faith Estimate.

For more information, visit www.cms.gov/nosurprises.

If you are uninsured or not using insurance, you have the right to receive a Good Faith Estimate (GFE) explaining the total expected cost of services. This estimate will be provided in writing prior to your first scheduled session or upon request.

Your GFE will include:

• The provider’s name, NPI number, and practice contact details
• The type of service(s) expected (e.g., intake, therapy sessions, evaluation, or reports)
• The estimated number of sessions and frequency, if known
• The estimated cost per session and total projected cost

Requesting a Good Faith Estimate

You may request a GFE at any time before scheduling or committing to services. Estimates are valid for 12 months from the date issued.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the charge. To start the dispute process, you must submit a request within 120 calendar days of the date on your bill.

For more information about your right to a Good Faith Estimate, visit:www.cms.gov/nosurprises/consumers

Claria Counseling accepts select insurance plans for therapy services. To make the insurance process smoother, Claria Counseling partners with Headway (also known as New York Behavioral Health, Inc.) to manage insurance verification, billing, and claims processing.

How Headway Works

• Headway acts as the billing and administrative platform through which Claria Counseling clinicians are credentialed with major insurance networks (such as Aetna, UnitedHealthcare, Cigna, Oxford, and others where applicable).
• When you book an insurance-based session with a Claria Counseling provider, your insurance information is securely collected and verified by Headway.
• Headway will submit claims to your insurance provider on behalf of Claria Counseling and will handle reimbursements, copayments, and account management.

Your Responsibilities

• You are responsible for verifying your insurance benefits and coverage prior to beginning services.
• You are responsible for any copays, coinsurance, or deductible amounts as determined by your plan.
• If your insurance denies coverage or if you lose eligibility, you will be responsible for the full session fee.

Billing Contact

If you have questions regarding insurance billing, claim status, or payment processing, please contact Headway directly:

Headway (New York Behavioral Health, Inc.)Website: www.headway.coEmail:

For non-insurance questions or concerns, you may contact Claria Counseling directly using the details below.

The following outlines standard self-pay rates for Claria Counseling services. These are estimates only and may vary based on your provider, session length, or clinical needs.

Service Type

Description

Estimated Fee (USD)

Initial Diagnostic Assessment

Comprehensive intake session (50–60 minutes)

$100–$150

Individual Therapy Session

45–55 minutes

$100–$150

Couples or Family Therapy Session

50–60 minutes

$120–$170

Psychosocial Evaluation (Immigration-related)

2–4 hour process including interview, report, and review

depending on case type

Clinical Supervision (LPC-Associate)

60-minute session

$60–$120

Insurance: Fees, copays, and deductibles vary depending on your insurance plan and Headway’s determination. Please verify coverage before your first session.

Sliding Scale: Limited reduced-fee slots may be available based on financial need.

• Payment is due at the time of service unless otherwise arranged.
• Accepted payment methods: credit/debit card, HSA/FSA, or approved electronic transfer.
• If services are billed through insurance, Headway manages the claim submission and remittance. You are responsible for any patient responsibility amounts assigned by your plan.
• Any changes in fees will be communicated in advance.

If you believe you have been billed incorrectly, would like to request a Good Faith Estimate, or have general questions about billing:

Claria Counseling9221 S Gessner RdHouston, Texas 77074 Email: Phone: (713) 373-1258

For insurance-related billing or claims assistance: Headway (New York Behavioral Health, Inc.) www.headway.co

You may also contact the U.S. Department of Health and Human Services (HHS) for information or to file a complaint:

Website: www.cms.gov/nosurprises Phone: 1-800-985-3059

This information is provided in compliance with the No Surprises Act and is for general informational purposes only. The Good Faith Estimate is not a contract and does not obligate you to receive services from Claria Counseling. Final charges may differ based on actual services provided.