kamili wade-reescano

Client Rights & Good Faith Estimate Notice

Access to Health Care Records

Clients have the right to request access to or copies of their health care records in accordance with Texas law.

To request your records, please submit a written request to:

Kamili Wade-Reescano / HIMPACT PLLC 
Email: kamili@himpactpllc.com 
Phone: 832-297-1945

Record requests will be processed within the timeframes required by applicable law and after receipt of a completed Release of Information form. Fees permitted by law may apply and may be required prior to release.

CLIENT RIGHTS, RECORDS, AND CONSUMER INFORMATION

This practice is licensed and regulated by the Texas Behavioral Health Executive Council (BHEC).

Clients may contact the Council using the information provided on their Contact Us webpage: https://bhec.texas.gov

Licensing and Regulatory Authority

Clients have the right to file a consumer complaint with the Texas Office of the Attorney General’s Consumer Protection Division.

Information about filing a complaint is available at: https://www.texasattorneygeneral.gov/consumer-protection

Consumer Complaints

Under federal law, clients who do not use insurance or who choose to self-pay have the right to receive a Good Faith Estimate of the expected cost of services.

A Good Faith Estimate will be provided:

Upon request at any time prior to receiving services

The estimate will include the expected cost of therapy services based on the information available at the time and may include:

Session fees
Frequency of sessions
Anticipated duration of treatment

Please note that the actual services provided and total cost may vary depending on your individual needs and treatment progress.

Dispute Resolution

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the U.S. Department of Health and Human Services (HHS) Patient–Provider Dispute Resolution process: https://www.cms.gov/nosurprises

For questions about fees, estimates, or billing, please contact:

Kamili Wade-Reescano / HIMPACT PLLC 
Email: kamili@himpactpllc.com 
Phone: 832-297-1945