Your Care, Your Rights

We want you to understand your rights regarding the cost of health care services.

What is a Good Faith Estimate (GFE)?

You have the right to receive a Good Faith Estimate (GFE), which explains how much your health care will cost. Providers must give this estimate to patients who do not have certain types of health care coverage, or who are not using certain types of coverage, before services are provided.

When Can You Request a Good Faith Estimate?

• You can request a GFE anytime before scheduling a service.
• If you schedule a service at least 3 business days in advance, the provider must give you a GFE within 1 business day.
• If you schedule at least 10 business days in advance, the GFE must be provided within 3 business days.
• You can also ask for a GFE before scheduling, and the provider must give it in writing within 3 business days.
   

Disputing a Bill

If your bill is $400 or more above the Good Faith Estimate from a provider or facility, you have the right to dispute the bill.

Important: Save a copy or photo of your Good Faith Estimate and the bill.

For questions about your rights or the dispute process, you can:

• Visit: www.cms.gov/nosurprises/consumers
• Email: FederalPPDRQuestions@cms.hhs.gov
• Call: 1-800-985-3059

Anna Stubbs, PLLC
info@annastubbs.co

This Notice of Privacy Practices describes how Anna Stubbs, PLLC may use and disclose protected health information about you and outlines your rights regarding that information. A full copy of the Notice of Privacy Practices is provided to all new clients as part of the intake paperwork and may be requested at any time from Anna Stubbs, PLLC.

Uses and Disclosures of Health Information

Anna Stubbs, PLLC may use or disclose your protected health information for purposes including, but not limited to: treatment, payment, scheduling, healthcare operations, safety, legal requirements, marketing, public health activities, appointment check-ins, health oversight activities, legal proceedings, breach notification, psychotherapy notes (as permitted by law), and research.

Except as outlined in this Notice of Privacy Practices, Anna Stubbs, PLLC will not use or disclose your identifiable health information without your written authorization, in accordance with applicable law. If you authorize the use or disclosure of your health information for a purpose not otherwise permitted, you may revoke that authorization in writing at any time.

Your Rights

You have rights regarding your protected health information, including the right to:

• Request special privacy protections
• Request confidential communications
• Inspect and obtain copies of your records
• Request amendments or supplements to your records
• Receive an accounting of disclosures
• Obtain a paper or electronic copy of this Notice of Privacy Practices
   

Changes to This Notice

Anna Stubbs, PLLC reserves the right to amend this Notice of Privacy Practices at any time. Until such changes are made, we are required by law to comply with the terms of the current Notice. Any revised Notice will apply to all protected health information maintained by the practice, regardless of when it was created or received. Updated versions will be included in informed consent materials and posted on our website.

Complaints

If you have concerns about this Notice of Privacy Practices or how your health information is handled, please contact the Privacy Officer at Anna Stubbs, PLLC using the contact information listed above.

If you are not satisfied with how your complaint is handled, you may submit a formal complaint to one of the following agencies:

Texas Department of State Health Services
Consumer Services and Rights Protection / Ombudsman Office
Mail Code 2019
P.O. Box 149347
Austin, TX 78714-9347
Phone: (512) 206-5760 or (800) 252-8154 (toll-free)

Office for Civil Rights (OCR), Region VI
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Phone: (800) 368-1019
Fax: (214) 767-0432
TDD: (800) 537-7697
Email: OCRMail@hhs.gov

The HIPAA complaint form may be found at:
www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf

You will not be penalized or retaliated against in any way for filing a complaint.

If you believe a clinician has violated their code of ethics and/or scope of their licensing regulations, please contact the licensing board.

Click here to access the Texas Code.

Texas Behavioral Health Executive Council

1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
(512) 305-7700
Investigations/Complaints 24-hour, toll-free system- (800) 821-3205

https://bhec.texas.gov/contact-us/