Policies & Legal
No Surprises Act
2870 Peachtree Rd NW Suite 915-8596 Atlanta, GA 30305
404-989-5547, info@trythewellnessroom.com, www.trythewellnessroom.com
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
OMB Control Number: 0938-1401
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Centers for Medicare & Medicaid at 1-800-985-3059 for more information. TTY users may call 1-800-985-3059. You may also visit the Georgia Secretary of State website: Click here or call 470-240-5060 to learn more.
Click here for more information about your rights under Federal law.
Click here to visit the CMS website for more information about your rights.
Download this form for your records: No Surprises
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with specific legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you how I may use and disclose health information about you. I also describe your rights to the health information I keep about you and my obligations regarding using and disclosing your health information. I am required by law to:
Make sure that protected health information ("PHI") that identifies you is kept private.
Give you this notice of my legal duties and privacy practices concerning health information.
Follow the terms of the notice that is currently in effect.
I can change the terms of this notice, which will apply to all information I have about you. The new notice will be available in my virtual office and website upon request.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Only some uses or disclosures in a category will be listed. However, all the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment Payment or Health Care Operations: Federal privacy rules (regulations) allow healthcare providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without the patient's written authorization, to carry out the health care provider's own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any healthcare provider, which does not require your written authorization. For example, if a clinician were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the clinician in diagnosing and treating your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Therapists and other healthcare providers need access to the entire record and complete information to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between providers, and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. I may keep "psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is: a.For my use in treating you. b.For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law, and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your authorization for the following reasons:
Progress Notes. I keep "progress notes" as that term is defined in the Rules and Regulations of the State of Georgia regarding medical records in Rule 111-8-40-.18. 3.a.13. Any use or disclosure of progress notes does not require your authorization. While HIPAA protects psychotherapy notes, progress notes are not. Progress notes can be released to a third party either without explicit consent from the client or after the client signs a generalized consent form.
Some insurance companies may even ask to see progress notes to approve services and provide payments.
When disclosure is required by state or federal law, the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse or preventing or reducing a serious threat to anyone's health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, I prefer to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners when such individuals perform duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of treatment for the same condition.
Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
For workers' compensation purposes, although I prefer to obtain authorization from you, I may provide your PHI to comply with workers' compensation laws.
For appointment reminders and health-related benefits or services, I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives or other healthcare services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other person you indicate, is involved in your care or the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or service you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than "psychotherapy notes," you have the right to get an electronic or paper copy of your medical record and other information I have about you. I will provide you with a copy of your record or a summary of it if you agree to receive a summary within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.
The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI or that a piece of important information needs to be added to your PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this notice via email, you also have the right to request a paper copy.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect upon receipt of the client's electronic signature.
Acknowledgment of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding using and disclosing your protected health information. By signing this document, you acknowledge receiving a copy of the HIPAA Notice of Privacy Practices
If you have any questions regarding our privacy practices, please contact us info@trythewellnessroom.com or send comments to:
The Wellness Room, LLC
The Wellness Room Coaching & Consulting, LLC
Attention: Dr. April Brown
2870 Peachtree Rd NW Suite 915-8596
Atlanta, GA 30305
We will make a reasonable effort to resolve any questions or concerns promptly.
Terms of Use
This website is owned by The Wellness Room, LLC (Therapy Services) and The Wellness Room Coaching & Consulting, LLC (Wellness Services).
Therapy services are defined as individual therapy, clinical supervision, and business consultation services. Wellness services are defined as wellness coaching, wellness speaking, wellness events, wellness retreats, and workplace consultations. All therapy services are billed under The Wellness Room, LLC, and wellness services are billed under The Wellness Room Coaching & Consulting, LLC. Please note that therapy services are unavailable to wellness service clients, and wellness services are unavailable to therapy clients. All clients may read our blog and purchase online products, but you agree to assume all risks.
By viewing this website or anything made available on or through this website, including but not limited to classes, programs, products, services, opt-in gifts, e-books, videos, webinars, blog posts, e-newsletters, consultations, emails, social media, and other communication (collectively referred to as "Website"), you are agreeing to accept all parts of this Disclaimer. Thus, if you disagree with the disclaimer statements and terms of use policies below, STOP now, and do not access or use this website.
For Educational and Informational Purposes Only.
The information provided in or through this website is for educational and informational purposes only and solely as a self-help tool for your own use.
Wellness coaching services are intended to provide guidance and support in achieving personal health and wellness goals. However, it is essential to note that coaches are not licensed healthcare professionals and do not provide medical advice, diagnosis, or treatment. Coaching is not a substitute for medical care or therapy, and clients should always consult with their healthcare provider before making any changes to their health regimen. Additionally, results may vary and are dependent on individual effort and commitment. Clients should understand that they are solely responsible for their own choices and actions.
Not Medical, Mental Health, or Religious Advice.
While I am a Mental Health Provider (diagnose and treat mental health conditions), I am not, nor am I holding myself out to be a doctor/physician, nurse, physician's assistant, advanced practice nurse, or any other medical professional ("Medical Provider"). Although I am a licensed professional counselor in Georgia (active) and a nationally certified counselor (active), I am not practicing as a Mental Health Provider within the context of the wellness coaching relationship. As a Professional Wellness Coach, I do not provide health care, medical or nutritional therapy services or attempt to diagnose, treat, prevent, or cure any physical, mental, or emotional issue, disease, or condition. The information provided in or through my website pertaining to your business, your career, or any other aspect of your life is not intended to be a substitute for the professional medical advice, diagnosis, or treatment provided by your own Medical Provider or Mental Health Provider. You agree and acknowledge that I am not providing medical, mental health, or religious advice in any way. Always seek the advice of your own Medical Provider and Mental Health Provider regarding any questions or concerns about your specific health or any medications, herbs, or supplements you are currently taking before implementing any recommendations or suggestions from our website. Do not disregard medical advice or delay seeking medical advice because of the information you have read on this website. Do not start or stop taking any medications without speaking to your own Medical Provider or Mental Health Provider. If you have or suspect a medical or mental health problem, contact your own Medical Provider or Mental Health Provider promptly. The Food and Drug Administration has not evaluated the information contained on this website.
Personal Responsibility.
You aim to accurately represent the information provided to us on or through our website. You acknowledge that you are participating voluntarily in using our website and are solely and personally responsible for your choices, actions, and results, now and in the future. You accept full responsibility for the consequences of your use, or non-use, of any information provided on or through this website, and you agree to use your own judgment and due diligence before implementing any idea, suggestion, or recommendation from my website to your life, family, or business.
No Guarantees.
My role is to support and assist you in reaching your own goals, but your success depends primarily on your own effort, motivation, commitment, and follow-through. I cannot predict, and I do not guarantee that you will attain a particular result, and you accept and understand that results differ for each individual. Each individual's results depend on their unique background, dedication, desire, motivation, actions, and numerous other factors. You fully agree that there are no guarantees as to the specific outcome or results you can expect from using the information you receive on or through this website.
Testimonials
I present real-world experiences, testimonials, and insights about other people's experiences with my website for purposes of illustration only. The testimonials, examples, and photos used are of actual clients and the results they personally achieved, or they are comments from individuals who can speak to my character and the quality of my work. They are not intended to represent or guarantee that current or future clients will achieve the same or similar results; rather, these testimonials represent what is possible for illustrative purposes only.
Assumption of Risk.
As with all situations, there are sometimes unknown individual risks and circumstances that can arise during use of my website that cannot be foreseen that can influence or reduce results. You understand that any mention of any suggestion or recommendation on or through my website is to be taken at your own risk, with no liability on my part, recognizing that there is a rare chance that illness, injury, or even death could result, and you agree to assume all risks.
Limitation of Liability.
By using this website, you agree to absolve me of any liability or loss you or any other person may incur from using the information, products, or materials you request or receive through or on my website. You agree that I will not be liable to you or any other individual, company, or entity, for any type of damages, including direct, indirect, special, incidental, equitable, or consequential loss or damages, for use of or reliance on my website. You agree that I do not assume liability for accidents, delays, injuries, harm, loss, damage, death, lost profits, personal or business interruptions, misapplication of information, physical or mental disease or condition or issue, or any other type of loss or damage due to any act or default by me or anyone acting as our agent, consultant, affiliate, joint venture partner, employee, shareholder, director, staff, team member, or anyone otherwise affiliated with my business or me, who is engaged in delivering content on or through this website.
Indemnification and Release of Claims.
You hereby fully and completely hold harmless, indemnify and release me and any of my agents, consultants, affiliates, joint venture partners, employees, shareholders, directors, staff, team members, or anyone otherwise affiliated with my business or me from any and all causes of action, allegations, suits, claims, damages, or demands whatsoever, in law or equity that may arise in the past, present or future that is in any way related to my website.
No Warranties.
I MAKE NO WARRANTIES RELATED TO THE PERFORMANCE OR OPERATION OF MY WEBSITE. I MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, AS TO THE INFORMATION, CONTENT, MATERIALS, PROGRAMS, PRODUCTS OR SERVICES INCLUDED ON OR THROUGH THE WEBSITE. TO THE FULL EXTENT PERMISSIBLE BY APPLICABLE LAW, I DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
Errors and Omissions.
Although every effort is made to ensure the accuracy of information shared on or through this website, the information may inadvertently contain inaccuracies or typographical errors. You agree that I am not responsible for the views, opinions, or accuracy of facts referenced on or through my website or of those of any other individual or company affiliated with my business or me in any way. Because scientific, technological, and business practices are constantly evolving, you agree that I am not responsible for the accuracy of my website or for any errors or omissions that may occur.
No Endorsement.
References or links in my website to the information, opinions, advice, programs, products, or services of any other individual, business, or entity do not constitute my formal endorsement. I am merely sharing information for your own self-help only. I am not responsible for the website content, blogs, emails, videos, social media, programs, products, and services of any other person, business, or entity that may be linked or referenced in my website. Conversely, should my Website link appear in any other individual's, business's, or entity's website, program, product, or services, it does not constitute my formal endorsement of them, their business, or their website.
Affiliates.
Occasionally, I may promote, affiliate with, or partner with other individuals or businesses whose programs, products, and services align with mine. In the spirit of transparency, I want you to be aware that there may be instances when I promote, market, share or sell programs, products, or services for other partners, and in exchange, I may receive financial compensation or other rewards. Please note that I am highly selective and only promote the partners whose programs, products, and services I respect. At the same time, you agree that any such promotion or marketing does not serve as any form of endorsement whatsoever. You are still required to use your judgment to determine whether any such program, product, or service is appropriate for you. You are assuming all risks, and you agree that I am not liable in any way for any program, product, or service that I may promote, market, share, or sell on or through my website.
Get in Touch.
You agree to all parts of the above Disclaimer by using my website. If you have any questions about this Disclaimer, please contact me at info@trythewellnessroom.com or send comments to:
The Wellness Room, LLC
The Wellness Room Coaching & Consulting, LLC
Attention: Dr. April Brown
2870 Peachtree Rd NW Suite 915-8596
Atlanta, GA 30305
We will make a reasonable effort to resolve any questions or concerns promptly.
CareCredit Cardholder Agreement
The Wellness Room, LLC is a registered CareCredit Merchant. Clients can pay for therapy using their CareCredit Healthcare Credit card.
Flexible Financing with CareCredit
The CareCredit health, wellness, and personal care credit card gives you a convenient, flexible way to pay for care for the whole family—including pets! With everyday promotional financing for purchases of $200 or more, you can pay over time with convenient monthly payments. *
See if you prequalify with no impact to your credit score Apply here.
* Subject to credit approval. Minimum monthly payments required. See carecredit.com for details.
Upon approval, you can pay for 12 weekly sessions upfront and receive a 5% discount per session. We offer 0% interest for the first 6 months. Pay your balance in full by the end of the promotional period to avoid paying interest. After 6 months, the remaining balance is subject to a 29.99% annual percentage rate (APR).
Review the CareCredit Cardholder Agreement for more information. Click here.
If you have any questions, don’t hesitate to contact me directly.