Policies & Legal
No Surprises Act
2870 Peachtree Rd NW Suite 915-8596 Atlanta, GA 30305
404-989-5547, info@trythewellnessroom.com, www.trythewellnessroom.com
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
OMB Control Number: 0938-1401
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Centers for Medicare & Medicaid at 1-800-985-3059 for more information. TTY users may call 1-800-985-3059. You may also visit the Georgia Secretary of State website: Click here or call 470-240-5060 to learn more.
Click here for more information about your rights under Federal law.
Click here to visit the CMS website for more information about your rights.
Download this form for your records: No Surprises
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with specific legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you how I may use and disclose health information about you. I also describe your rights to the health information I keep about you and my obligations regarding using and disclosing your health information. I am required by law to:
Make sure that protected health information ("PHI") that identifies you is kept private.
Give you this notice of my legal duties and privacy practices concerning health information.
Follow the terms of the notice that is currently in effect.
I can change the terms of this notice, which will apply to all information I have about you. The new notice will be available in my virtual office and website upon request.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Only some uses or disclosures in a category will be listed. However, all the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment Payment or Health Care Operations: Federal privacy rules (regulations) allow healthcare providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without the patient's written authorization, to carry out the health care provider's own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any healthcare provider, which does not require your written authorization. For example, if a clinician were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the clinician in diagnosing and treating your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Therapists and other healthcare providers need access to the entire record and complete information to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between providers, and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. I may keep "psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is: a.For my use in treating you. b.For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law, and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your authorization for the following reasons:
Progress Notes. I keep "progress notes" as that term is defined in the Rules and Regulations of the State of Georgia regarding medical records in Rule 111-8-40-.18. 3.a.13. Any use or disclosure of progress notes does not require your authorization. While HIPAA protects psychotherapy notes, progress notes are not. Progress notes can be released to a third party either without explicit consent from the client or after the client signs a generalized consent form.
Some insurance companies may even ask to see progress notes to approve services and provide payments.
When disclosure is required by state or federal law, the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse or preventing or reducing a serious threat to anyone's health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order, I prefer to obtain an Authorization from you before doing so.
For law enforcement purposes, including reporting crimes occurring on my premises.
To coroners or medical examiners when such individuals perform duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of treatment for the same condition.
Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
For workers' compensation purposes, although I prefer to obtain authorization from you, I may provide your PHI to comply with workers' compensation laws.
For appointment reminders and health-related benefits or services, I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives or other healthcare services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other person you indicate, is involved in your care or the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or service you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than "psychotherapy notes," you have the right to get an electronic or paper copy of your medical record and other information I have about you. I will provide you with a copy of your record or a summary of it if you agree to receive a summary within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.
The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI or that a piece of important information needs to be added to your PHI, you have the right to request that I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this notice via email, you also have the right to request a paper copy.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect upon receipt of the client's electronic signature.
Acknowledgment of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding using and disclosing your protected health information. By signing this document, you acknowledge receiving a copy of the HIPAA Notice of Privacy Practices
If you have any questions regarding our privacy practices, please contact us info@trythewellnessroom.com or send comments to:
The Wellness Room, LLC
Attention: Dr. April Brown
2870 Peachtree Rd NW Suite 915-8596
Atlanta, GA 30305
We will make a reasonable effort to resolve any questions or concerns promptly.
Terms of Use
Last Updated: December 2025
This website is owned and operated by The Wellness Room, LLC, a Georgia limited liability company (“Company,” “we,” “us,” or “our”). By accessing or using this website and any related digital content, you (“user,” “you,” or “your”) agree to be bound by these Terms of Use and our Privacy Policy.
If you do not agree, please do not use this website or any of our services.
1. Purpose and Scope
This website and its related services provide educational, informational, and consulting resources related to mental health, wellness, self-care, and business development. Offerings include, but are not limited to:
Wellness workshops, retreats, and speaking engagements
Corporate wellness consulting and private practice consultations
Digital products (e.g., e-books, journals, videos, and resources)
Blog posts, newsletters, and other informational content
The materials on this website are for educational and informational purposes only. They are not a substitute for professional therapy, medical advice, or clinical care.
2. No Therapy or Clinical Services
While Dr. April Brown is a Licensed Professional Counselor (LPC) in Georgia, this website does not provide therapy, diagnosis, or treatment.
All existing clinical work occurs exclusively with established clients through a secure, HIPAA-compliant electronic health record (EHR) system and is separate from this site.
By engaging with this website, you acknowledge that:
You are not entering a client-therapist relationship with The Wellness Room, LLC.
Content, consultations, or digital materials provided are not mental health treatment.
You are solely responsible for seeking professional care from your own licensed provider as needed.
3. Educational and Consulting Services Disclaimer
Training and consulting services offered through this site (including private practice consultations, workshops, and speaking engagements) are educational in nature. They are intended to guide, inform, and support your personal or professional growth, but they are not a substitute for medical, psychological, or financial advice.
We make no guarantees about results or outcomes. Your success depends on your own participation, decisions, and circumstances.
4. Digital Products and Intellectual Property
All content, including brand assets, digital downloads, videos, handouts, and written materials, are the intellectual property of The Wellness Room, LLC.
You may not reproduce, distribute, modify, or share any materials without written permission.
All digital products are non-refundable due to their immediate and irrevocable nature upon download or access.
5. Testimonials and Illustrative Results
Testimonials featured on this website represent real experiences but do not guarantee similar results.
They are shared for illustrative and educational purposes only.
6. Assumption of Risk
By using this website, you acknowledge that participation in any activity, workshop, retreat, or consultation involves inherent personal risk.
You agree to assume full responsibility for your use or misuse of any content or recommendations provided.
7. Limitation of Liability
To the fullest extent permitted by law, The Wellness Room, LLC, its owners, employees, and affiliates are not liable for any damages arising from:
Your reliance on information provided on this website
Errors, omissions, or inaccuracies in content
Delays, interruptions, or technical issues
In no event shall The Wellness Room, LLC be liable for indirect, incidental, consequential, or punitive damages, even if advised of the possibility.
8. Indemnification
You agree to indemnify, defend, and hold harmless The Wellness Room, LLC and its affiliates from and against any and all claims, liabilities, damages, losses, and expenses (including reasonable attorneys’ fees) arising from your use of this website or violation of these Terms.
9. Affiliate Relationships
Occasionally, this website may include affiliate links.
This means we may earn a small commission if you purchase through those links—at no additional cost to you.
All affiliate relationships are disclosed in accordance with FTC guidelines.
10. Errors, Omissions, and External Links
We strive for accuracy, but we cannot guarantee that all information is complete or current.
Links to external websites are provided as a resource; The Wellness Room, LLC is not responsible for their content or policies.
11. Governing Law and Dispute Resolution
These Terms are governed by the laws of the State of Georgia, without regard to conflict of law principles.
You agree that any dispute arising from these Terms shall be resolved through mandatory mediation and, if necessary, binding arbitration in Fulton County, Georgia.
Each party shall bear its own costs and attorneys’ fees. Arbitration shall be conducted by a neutral arbitrator in accordance with the rules of the American Arbitration Association (AAA).
12. Changes to Terms
We reserve the right to update or modify these Terms at any time.
Any updates will be reflected by a revised “Last Updated” date above. Continued use of the website constitutes your acceptance of such changes.
13. Contact Us
If you have questions about these Terms or wish to request permission for content use, please contact:
The Wellness Room, LLC
Attn: Dr. April Brown
2870 Peachtree Rd NW, Suite 915-8596
Atlanta, GA 30305
📧 info@trythewellnessroom.com