Frequently Asked Questions

How to File a Complaint

You have a right to have your complaints heard and resolved in a timely manner. If we cannot work things out to your satisfaction, you may file a complaint with our licensing board:

Texas Behavioral Health Executive Council
1801 Congress Avenue, Suite 7.300
Austin, TX 78701
Telephone: 1-800-821-3205
Link to Complaint Form: http://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf.

If you have a complaint concerning the HIPAA Privacy Regulations, you may contact the U. S. Department of Health and Human Services, Office for Civil Rights, at: OCRMail@hhs.gov.

If you believe that you have a Consumer Complaint regarding the privacy and security of your health information, you may contact the Texas Office of the Attorney General and file a consumer complaint by clicking this link:
https://www.texasattorneygeneral.gov/consumer-protection/health-care/patient-privacy

No Surprises Act and Good Faith Estimate Dispute Process

Transparency in fees and charges is an important part of the therapeutic relationship.  In accordance with the No Surprise Act, Madeleine Brunk, LCSW, provides Good Faith Estimates to all clients. The Good Faith Estimate shows the cost of items and services that are reasonably expected for your health care needs for an item or service.

The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that might arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.  Ultimately, this clinician prioritizes working with clients and/ or their families to create a treatment plan that meets the client's emotional needs with clear communication about treatment costs.  Frequency and duration of sessions are an ongoing and open conversation.  

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the health care provider or facility to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date of the original bill. 

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. 

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at (800) 368-1019.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 368-1019.

Keep a copy of the Good Faith Estimate in a safe place or take a picture of it. You may need it if you are billed a higher amount.​

If you are having issues accessing any part of this site, please email me at maddie@madeleinebrunkcounseling.com