Professional Fees
Fees depend on the type of sessions and services provided. Please call for information specific to your needs. Following our initial contact in which we determine professional services requested and to be delivered, a “Good Faith Estimate” and fee structure will be provided.
Good Faith Estimate
In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their federal rights and protections against “surprise billing.”
This Act, designed to protect consumers from medical facilities subcontracting services out, blanketly includes licensed “Health Service Providers” in the law which requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance. As a provider who is not a contractor with insurance companies, I agree to clearly inform you of my billing practices.
Additionally, we are required by that law to provide you with a Good Faith Estimate of the cost of services prior to having ever met or spoken with you, which is unrealistic for the services I provide. It is difficult to determine the exact length of services for psychotherapy, counseling, coaching, or consultation, considered “mental health care”, and each client has a right to decide how long they would like to participate in receiving “mental health services”. Therefore, we will readily provide you an intake fee quote, and once having determined the services to be provided, we will provide an up-to-date fee schedule for the services typically offered as a psychologist, counselor, coach, or consultant, and we will collaborate with you on a regular basis to determine the trajectory of care.
It is a federal requirement that we have each client sign this form to begin/resume treatment. Please sign, date, and return it before your next appointment. If you have any questions, please don’t hesitate to ask.
Fees are calculated based on a 50” hour, in quarter hour increments, and vary with service provides, and degree of collateral coordination expected to be necessary. Prior to beginning services, you will have a conversation about fees with Dr. Heidi Lack, and signing this agreement affirms your acceptance of the fees identified, which is subject to annual cost of living increases, and your taking full responsibility for payment in a timely manner, regardless of insurance reimbursement to you directly. In addition to face-to-face or telehealth consultation/therapy/coaching services, we charge for other services you may need or request including telephone conversations lasting longer than 10 minutes, lengthy e-mail communications, letters, attendance at meetings you have authorized, preparation of treatment summaries, and other requested services. The Good Faith Estimate will include a comprehensive fee schedule.
Billing and Payments
At the time you book a first appointment, you will be asked to provide a cell phone number through which you may pay for services through Ivy Pay, a HIPAA Approved credit card processing company, through which you will be billed and pay directly for services after each service delivery. Alternatively, if you are seen in person you may pay by check, or cash at the office at 16 Clarke. St. #23, Lexington, MA, 02421.
Dr. Heidi Lack has the right to postpone additional services if a prior account balance has not been paid, if the credit card on file cannot be authorized, or if prior payment arrangements have not been made. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. In most situations, the only information released regarding a client’s treatment is his/her name, the nature of services provided, and the amount due but this is not guaranteed.
Once services are rendered and paid for, there are no refunds, regardless of insurance company reimbursement decisions in the future. It is your responsibility to verify the specifics of your insurance coverage if relevant, and it is your responsibility to pay for services rendered by this practice.
Cancellation Policy
Given that a booked appointment is a time reserved for you, we require 48 business hours-notice if you need to change, cancel, or postpone a previously scheduled appointment without incurring the full charge for the appointment. Please note that most insurance companies do not reimburse for missed sessions.
Insurance Reimbursement
Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance company. Upon request, Dr. Heidi Lack can provide Superbills, which may be used by psychotherapy, counseling and consultation clients to submit to their insurance company for possible reimbursement, if desired. Insurance companies do not reimburse for coaching, teaching, public speaking, or supervision, or missed appointments and not all mental health related services/diagnoses or conditions are reimbursed by insurance companies (For example, Sensory Processing Disorder, Misophonia, or being Gifted are not diagnosable, billable ‘conditions’ at this time.)
Potential Costs Attached to Insurance Reimbursement
While there are definite benefits to receiving insurance reimbursement, you should also be fully informed of any potential hidden costs.
You should be aware that most insurance companies require Dr. Heidi Lack to provide them with a clinical diagnosis. On rare occasions additional clinical information such as a summary or phone consultation is needed and will be provided according to the fee schedule. Increasingly however, insurance companies are requesting the full record in order to reimburse clientele for out of network services paid directly to the practitioner, thereby effectively encouraging policy holders to self-pay for services rather than risk their private information be released, and housed in national databases, with possible future negative repercussions. Please note that Dr. Heidi Lack is not contracted with, a provider for, or empaneled on any insurance companies, and so does not communicate with, or receive payment directly from them. It is this office’s policy to keep documentation and content of sessions private and confidential, thus we do not, within confines of the law, release “full records” or “charts” to insurance companies.
Superbills provided to clients will document provider license and EIN number, address, contact information to authenticate credentials of the provider. They will include client identifiers used in this practice, dates, duration, location of service, CPT codes (for session type and length), ICD (diagnostic) coding which often satisfies insurance company needs to authenticate and document services for reimbursement purposes. Please note: these are HIPAA protected information. By submitting this receipt to your insurance company for reimbursement you are ostensibly releasing from your and this practice’s protection, your HIPAA protected private information.
Any information in charts or bills, when shared with insurance companies, becomes part of the insurance company files, stored in perpetuity on a computer or in the cloud. Though insurance companies claim to keep such information confidential, certain diagnoses can have financial implications down the line when applying for disability, life, or other forms of insurance. Dr. Heidi Lack has no control over what insurance companies do with this confidential information once it is in their hands, and for this reason it is the policy of this practice not to share any client’s full file/chart.
While most clients in Massachusetts receive a large percentage of this office’s fees back from insurance, call your insurance carrier to determine the reimbursement rate for out-of-network licensed psychologist services specific to your plan or circumstances.
Contacting Us
When Dr. Heidi Lack is in the office, she is usually seeing clients, so may not be immediately available by telephone. When unavailable, our telephone is answered by voicemail. We will make every effort to return your call within a few days, with the exception of weekends, holidays and vacations. If you are unable to reach us and feel you cannot wait for a returned call, contact your family physician or the nearest emergency room and ask for the psychologist on call. If Dr. Heidi Lack will be unavailable for an extended time, we will provide you with the name of a colleague to contact, if necessary. Communication pertaining to last minute issues related to imminent appointments are best communicated via email at HL@DrHeidiLack.com.
Confidentiality of Email, Cellphone, Fax, Zoom, and Credit Card Communication
It is very important to be aware that e-mail, texts and cell phone (also cordless phones) communication can be relatively easily accessed by unauthorized people and hence, the privacy and confidentiality of such communication can be easily compromised. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. Faxes can be sent erroneously to the wrong address. The form of videoconferencing and Credit Card processing utilized in this practice for TeleHealth is for professional paid use, encrypted, and HIPAA compliant, however, no practice can guarantee there will never be breaches to the databases of these companies. While Dr. Lack has made a good faith effort to ensure confidentiality of all technical aspects of this practice, neither the practice, “Exceptionally Wired”, nor Dr. Heidi Lack may be held responsible or liable for any repercussions arising from third party violations of confidentiality, anonymity, or breaches of private information. Please notify us at the beginning of services if you decide to avoid or limit in any way the use of any or all of the above-mentioned communication or processing systems. Please do not use e-mail or faxes in emergency situations. Head to your local emergency room, or call 911.
Litigation Limitation
Due to the nature of the therapeutic or evaluation process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc…), neither you (client’s) nor your attorney’s, nor anyone else acting on your behalf will call on us to testify in court or at any other proceeding, nor will a disclosure of the psychotherapy/counseling/coaching/consultation records be requested. If you become involved in a legal proceeding that requires our participation, however, you will be expected to pay for our professional time, even if we are called to testify by another party. Due to the particularly demanding requirements of the legal system, we charge $500 per hour for these services, regardless of which “side” of a legal conflict calls on us to participate.