Payment Policy
Kirsten Book, LLC is an out-of-network provider. I am not contracted with insurance plans. This means you will pay me directly and request out of network reimbursement from your insurance company.
It is solely the patient’s responsibility to check with their insurance regarding their out-of-network benefits. A super bill, if requested, will be provided to submit to your insurance company if you choose.
In order to schedule and hold your Initial Evaluation appointment time, the full evaluation fee must be paid in advance and is non-refundable if you No-Show your appointment
Advantages to paying out-of-pocket
- Choice
- Privacy
- Timeliness
- Flexibility
- Convenience
Cancellation Policy
Appointments must be canceled at least 24 hrs prior to the scheduled appointment time. Failure to cancel 24 hrs prior to or not showing for a Medication Management Follow-up appointment will result in a No-Show Fee equal to the full amount of the appointment.
Failure to cancel 24 hours or more prior to or not showing up for any appointment will result in a No- show fee equal to the full amount of the appointment
The Right to a Good Faith Estimate
You have the right to receive a “good faith estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services.
If you schedule a health care item or service at least three (3) business days in advance, you may request that your health care provider or facility provides you with a Good Faith Estimate in writing within one (1) business day after scheduling.
If you schedule a health care item or service at least ten (10) business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within three (3) business days after scheduling.
You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. In doing so, make sure the health care provider or facility gives you a Good Faith Estimate in writing within three (3) business days after you ask.
If after a Good Faith Estimate has been provided and you receive a bill that is a minimum of $400 or more for any provider or facility than your Good Faith Estimate from that provider or facility, you have the right to dispute the bill.
Each Good Faith Estimate is valid for 365 calendar days
Make sure to save a copy or picture of your Good Faith Estimate and the bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, or email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
No Surprises Act
In compliance with the “No Surprises Act” starting on 1/1/2022 “Good Faith Estimates” are available upon request and will be provided to all patients within 3 business days.
