Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health 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 expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.


Records Retention

In accordance with Arizona Revised Statutes § 12-2297 and § 32-3211, this document describes the practice policy on record storage, transfer, and requests. The time frames listed are estimates and not specified by the above statutes.

1. In the event I close or sell my practice and patients’ medical records will not remain in the same physical location, I shall notify each patient in a timely manner (est. 30 days or more) before closure or sale regarding the future location of patients’ physical and electronic medical records. Patients seeking a copy of their records can submit a release of information form and I will furnish digital copies of the records.

2. I may dispose of unclaimed medical records after making a good faith effort to contact former patients. If the patient is an adult, I will retain their record for at least six years after the last date the adult patient received services from me. If the patient is a child, I will retain their record either for at least three years after the child's eighteenth birthday or for at least six years after the last date the child received services from me, whichever date occurs later.

3. I shall respond in a timely manner (est. 14 days or fewer) to requests from patients for copies of their medical records or to access their medical records. Written release of information from the patient is required to process records requests.

4. I am only able to furnish patient records from services rendered in my private practice. Patient records from services rendered through a previous agency are held by the agency.

In accordance with Arizona Revised Statutes § 12-2297 and § 32-3211, this document describes the practice policy on record storage, transfer, and requests. The time frames listed are estimates and not specified by the above statutes.

1. In the event I close or sell my practice and patients’ medical records will not remain in the same physical location, I shall notify each patient in a timely manner (est. 30 days or more) before closure or sale regarding the future location of patients’ physical and electronic medical records. Patients seeking a copy of their records can submit a release of information form and I will furnish digital copies of the records.

2. I may dispose of unclaimed medical records after making a good faith effort to contact former patients. If the patient is an adult, I will retain their record for at least six years after the last date the adult patient received services from me. If the patient is a child, I will retain their record either for at least three years after the child's eighteenth birthday or for at least six years after the last date the child received services from me, whichever date occurs later.

3. I shall respond in a timely manner (est. 14 days or fewer) to requests from patients for copies of their medical records or to access their medical records. Written release of information from the patient is required to process records requests.

4. I am only able to furnish patient records from services rendered in my private practice. Patient records from services rendered through a previous agency are held by the agency.

Growing A Bonsai

Phoenix, Arizona

Ryan@GrowingABonsai.com

(602) 609-6505

Resources

National Suicide Prevention Lifeline: 988
Local Crisis Hotline: 602-222-9444
Local Crisis Warmline: 602-347-1100
Crisis Text Line: text “HOME” to 741-741
Teen Lifeline: 1-800-248-TEEN
National Trans Lifeline: 877-565-8860

Policy Documents

© 2024 Growing A Bonsai, LLC.

Growing A Bonsai

Phoenix, Arizona

Ryan@GrowingABonsai.com

(602) 609-6505

Resources

National Suicide Prevention Lifeline: 988
Local Crisis Hotline: 602-222-9444
Local Crisis Warmline: 602-347-1100
Crisis Text Line: text “HOME” to 741-741
Teen Lifeline: 1-800-248-TEEN
National Trans Lifeline: 877-565-8860

Policy Documents

© 2024 Growing A Bonsai, LLC.