Notices

Three Rivers Mental Health complies with applicable federal civil rights laws. We do not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability or sex.

We provide, at no cost and in a timely manner:

• Reasonable changes to our policies and practices, and aids and services, so people with disabilities can communicate with us effectively, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats).
• Language assistance for people whose primary language is not English, such as qualified interpreters and information written in other languages.

To ask for these services, call (857) 229-2852 or email info@threeriversmentalhealth.com.

If you believe we have failed to provide these services or discriminated in another way, you can file a grievance with our Section 1557 Coordinator. Contact details for the coordinator are coming soon; until then, call (857) 229-2852.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, online at the OCR Complaint Portal (opens in a new tab), or by mail or phone: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201; 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are at hhs.gov/ocr/complaints (opens in a new tab).

Free language assistance is available. If you need an interpreter, or information in another language or another format such as large print, call (857) 229-2852 (TTY: 711) or email info@threeriversmentalhealth.com. These services are free.

This notice in other languages is coming soon.

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers (opens in a new tab), email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.