**The email used by ATS is encrypted and may go to your junk box, please add jennifer@changeforyourlife.com to your contacts.**

Jennifer Baker LPC RPT ACS is an out-of-network provider and you may choose to have her bill electronically for you or give you a superbill to submit to your insurance for reimbursement.
 
Please check with your insurance to see if you are covered and what the reimbursement would be, if any.

 If you have health insurance, and the services you are seeking are covered by your health care plan, you may be able to get the items or services described in this notice from providers who are in-network with your health plan.

Questions to ask your insurance company:
1. Does my policy include outpatient mental/behavioral health coverage?
2. Does my plan cover out-of-network LPC's?
3. What % of the fee do they pay for OON LPC's?
4. Do they cover the codes being used?
5. What is my mental health/behavioral health deductible and how much has been met so far?

By booking an appointment: The client, Policy holder (s), and Legal Guardian (s) are legally bound & responsible for managing your account and payment of professional services rendered regardless of your coverage.

Your insurance company may be billed electronically, or you can request a receipt,  and the following codes may be  used, but not limited to:
90791 (intake 60 minutes) $195
90834 (therapy session 45+ minutes) $175
90847 (family with patient present) $175
90846 (family session without patient present) $175

Please refer back to www.changeforyourlife.com for Legal,  Office & Privacy policies and GFE details.


You will receive a receipt email from this form confirming your submission.