• Psychiatric Diagnostic Evaluation - 60 minutes - $185

    Psychotherapy Session - 50 minutes - $185

  • In-Network:

    • Regence BlueCross BlueShield of Oregon

    • Healthcare Management Administrators (HMA)

    • Providence Health Plan (PHP)

    • PacificSource

    • Aetna

    • MODA

    • Meritain Health

    • SANA BENEFITS

    Out-of-Network:

    • United Health Care (UHC)

  • I will complete a benefits check for you as a courtesy, typically prior to your 15-minute consultation (time permitting).

    You can also contact your insurance company directly and do this. Call the number on the back of your insurance card and provide them with my NPI# 1568620011, to verify if I am “in-network” with your plan. Then ask for a quote of your benefits for:

    • Outpatient Mental Health Telehealth services

    • What is your copay or co-insurance?

    • Does any deductible apply?

  • I can accept almost any kind of credit or debit card, including:

    • Visa, MasterCard, American Express, JCB, Discover, and Diners Club

    • FSA and HSA cards for client payments

    In order to start services, you will be asked to put a credit card on file to cover the cost of services or fees.

    Your card will be charged, typically, within 24 hours of each services.

  • Regular attendance and engagement at scheduled appointments is a key component of successful counseling.

    To avoid a cancellation fee of $185, please ensure that you provide at least 48 hours or twobusiness days' notice if you need to reschedule or cancel an appointment.

    Please remember that Saturdays, Sundays, and national holidays are not considered business days, so any cancellation notice given on these days will be considered received on the following business day.

    No Shows:

    If you are running a few minutes late, I may give you a call or resend the appointment link after about five minutes. I may also reach out via portal message.

    Please note that if you are not in the virtual office within 15 minutes of your scheduled appointment time, a No Show fee will be applied and the appointment will be terminated.

  • HEAVERLO COUNSELING LLC

    No Surprise Act

    Effective January 1, 2022 Congress passed the No Surprise Act (NSA) as part of the

    Consolidated Appropriations Act of 2021. The NSA is designed to protect patients from surprise bills at

    out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only

    for in-network cost-sharing amounts. The NSA also enables uninsured patients to receive a Good Faith

    Estimate of the cost of care. Surprise billing occurs when clients receive care from out-of-network

    providers without their knowledge. Surprise billing results in higher costs for medical services that would

    have been cheaper if rendered by providers inside the patients’ health plan network. NSA is intended to

    cut down on surprise costs and also to ban out-of-network charges without advance notice (providing

    clients plain-language consumer notice).

    Consumer Notice: It is a requirement that out-of-network providers provide all potential clients with

    notice that they are outside of the client’s health plan network. All potential clients may waive paying

    out-of-network prices for non-emergency services so long as they consent. Good Faith Estimate You

    have the right to receive a “Good Faith Estimate” explaining how much your medical care (in this case,

    specifically mental health counseling services) will cost. Under the law, healthcare providers are

    required to provide a Good Faith Estimate to out-of-network/cash pay clients when they seek services.

    Providers are required to:

    ● Provide a Good Faith Estimate to an uninsured (or self-pay) individual: ○ Within 1 business day after

    scheduling (this timeline applies when the primary item or service is scheduled at least 3 business days

    before the day the client or patient would receive it) or no later than 3 business days after scheduling

    (this timeline applies when the primary item or service is scheduled at least 10 business days before the

    client or patient would receive it), depending on scheduling; or ○ Within 3 business days after an

    uninsured (or self-pay) consumer requests a Good Faith Estimate.

    ● Include in the Good Faith Estimate an itemized list of each item or service, grouped by each provider

    or facility offering care. Each item or service must share specific details and the expected charge;

    ● Provide a paper or electronic copy of the Good Faith Estimate, even if the provider also provides the

    Good Faith Estimate information to the individual over the phone or verbally in-person;

    ● Provide the Good Faith Estimate using clear and understandable language;

    ● If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill;

    ● You may request that I provide this notice to you in paper or electronic format;

    ● The form will clearly state I am an out-of-network provider and provide an estimate of the cost of my

    services (which I will have calculated in good faith). You are never required to give up your protections

    from surprise billing. You also are not required to get out-of-network care. You can choose a provider or

    facility in your plan’s network.

    Lastly, there is a requirement which states that out-of-network providers must notify health plans when

    they provide a client service, and they must certify that they have met the required notice and consent

    requirements. I will keep these records for a minimum of seven years.

    Complaints: If you think you have been wrongly billed or are uncertain whether the No Surprises Act

    applies to you or if you have any additional questions you may call Sarah J. Heaverlo, LPC at or send an email

    to info@heaverlocounseling.com You may also contact: The Oregon Board of Licensed Professional

    Counselors and Therapists: (503) 378-5499 or lpct.board@mhra.oregon.gov; The U.S. Centers for

    Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit

    https://www.cms.gov/nosurprises for more information about your rights under federal law