Margo Bristow LLC

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Comprehensive training, coding and coaching, consultation, and therapy.

 
Motivational Interviewing, Process, Chemical Addictions, and Mental Health Counseling
Consultation, Training, Treatment, Coding, and Counseling
Member of the Motivational Interviewing Network of Trainers (MINT)

Margo Bristow is a Psychotherapist with a Masters in Counseling Psychology and is Licensed in Illinois as a LPC. Margo is an Adjunct Instructor  at Lewis University in Romeoville, Illinois and is a Member of the MINT. She is Certified as a Substance Abuse and Problem and Compulsive Gambling Counselor, Anger Management Specialist, and her work focuses on Youth with chemical and Process Addictions of Gaming, Gambling, Internet, and Social Media for the past 40 years. Margo has been happy to travel the world providing training (MI and Addictive behaviors) throughout the United States, Canada, Ireland, and Estonia.


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Client Intake Form
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Mental Health Treatment Release of Information
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HIPPA Notice Form
Telehealth Informed Consent
Good Faith Estimate and No Suprises Act

  • The Good Faith Estimate shows the costs 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 may 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.
  •  If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
  • You may contact the health care provider or facility listed 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 on 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 this 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.

 For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises.

 


Contact Margo Bristow at mb@margobristow.com or at (847) 791-1651.

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