Private Pay
For pay-as-you-go clients
Use this option if you are a a private-pay client and wish to pay for a past or future session(s). You are welcome to pay in advance of upcoming session.
Retainer Pay
For payments into your trust
Use this option if you receive services on “retainer” or an advance fee basis (most court-involved clients). Or use the payment link found in your last invoice email.
No Surprises Act Standard Notice
“Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act”
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item.You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good FaithEstimate, you can dispute the bill.
Make sure to save a copy or picture of yourGoodFaithEstimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call Dr. DiCarlo at 480-855-1600.
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