I am an in-network provider with Aetna, Magellan, Carefirst BCBS, and Cigna. Your health insurance or employee benefits plan may cover services in full or in part. It is every client’s responsibility to ensure you understand your benefits before starting services.

Ask these questions to your insurance provider to help determine your benefits:

• Does my health insurance plan include mental health benefits
• Do I have a deductible? If so, what is it, and have I met it yet? And what is my copay?
• Does my plan limit the number of sessions per calendar year? If so, how many sessions am I allowed per year?
• Do I need written approval from my primary care physician for services to be covered?

Out-of-Network Benefits:

If I do not participate with your insurance, you will want to verify your out-of-network benefits for mental health services. You will first pay for your sessions out-of-pocket, then I will provide you with monthly claim forms to submit to your insurance company for reimbursement. Some insurance companies reimburse up to 80%. You must find out the percentage your plan will reimburse from your insurance company.

The “No Surprises Act” and “Good Faith Estimates”

Background:

The No Surprises Act was passed in December 2020, under Section 2799B-6 of the Public Health Service Act, with the aim of protecting consumers from receiving unexpected medical bills. Additional consumer protections include new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. With this act, high out-of-pocket costs will be restricted, and emergency services must continue to be covered without prior authorization, regardless of whether a provider or facility is in-network.

The “Good Faith Estimate” provision of the No Surprises Act federally mandates that healthcare providers must give uninsured and self-pay clients an estimate of anticipated healthcare items and services, using a “Good Faith Estimate” upon request. This took effect on January 1, 2022.

What is a “Good Faith Estimate”?

A “Good Faith Estimate” estimates the total expected costs of non-emergency healthcare items or services. 

The purpose of this estimate is to:

Offer predictability & transparency in how much clients will be charged for healthcare services before their appointment. It includes all regularly scheduled appointments (i.e., therapy sessions).

It does NOT include no-shows, late cancellations, or other services related to crisis care, which are considered unexpected events and cannot be predicted to compile a Good Faith Estimate in advance. 

It may also include consultations with client contacts involving fees related to paperwork requests and other legal and administrative fees related to client care when such items are scheduled in advance.

If you are an uninsured or self-pay client (or if you request it), I will provide you with a “Good Faith Estimate.” The estimate will provide your estimated costs over 12 months. Overall, your estimate will give you a reasonable idea of what to expect regarding therapy costs for one year based on my current rates and the frequency of sessions we mutually agreed upon in advance.

What are your rights as a client?

As a client, your rights as they pertain to the No Surprises Act include:

The right to receive a “Good Faith Estimate” if you are uninsured or choose to pay out-of-pocket for services not covered by insurance or because you do not want to use your insurance company for services. You have the right to receive a “Good Faith Estimate” for the total expected cost of any non-emergency healthcare service or items. You have the right to dispute a bill that exceeds your “Good Faith Estimate.” The federal government offers a dispute resolution process for this purpose. 

When do you need to receive the “Good Faith Estimate”?

The law sets specific guidelines for when a client must be given a “Good Faith Estimate.”

If a service is scheduled at least ten business days in advance, the “Good Faith Estimate” must be provided within three business days. (This is within three business days of the scheduling, not the appointment itself.)If a service is scheduled at least three business days in advance, the “Good Faith Estimate” must be provided within one business day of scheduling.If a service is scheduled less than three business days in advance, a “Good Faith Estimate” is not required. I am required by law to send all uninsured or self-pay clients new “Good Faith Estimates” every 12 months; clients cannot opt-out and must acknowledge receipt and understanding of each new “Good Faith Estimate” to comply with federal law.

Disclaimers:

The “Good Faith Estimate” information is only an estimate. Actual healthcare items, services, or charges may change throughout the year, even for long-term established clients. I may revise your estimate for new clients once we have met and discussed more details about your symptoms and treatment plan, which may not be reflected in the “Good Faith Estimate” you initially received. 

However, I will never schedule healthcare services or items without client consent, and clients may request an updated “Good Faith Estimate” at any time. 

The Good Faith Estimate is not a contract; it does not bind, obligate, or require any client to obtain healthcare services or items from me at any time. It does not obligate me to continue to provide assistance if an issue arises during treatment that is outside of my area of expertise.

“Good Faith Estimates” are not required for emergency services, which cannot be scheduled in advance. No federal provisions allow clients to waive their right to a “Good Faith Estimate” now. The regulation allows clients to waive some of the protections related to balance billing, but does not allow me as a therapist to bypass the “Good Faith Estimate” through a client waiver.

Disputing Charges:

If you are billed for more than what was provided on your “Good Faith Estimate,” you can dispute the bill.

To Dispute a bill:

You can 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 financial assistance is available.

You may 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 four 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, you will pay the price on the original 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 dispute process, visit: www.cms.gov/nosurprises or call the U.S. Department of Health and Human Services at 1-877-696-6775.

For questions or more information about your right to a “Good Faith Estimate” or on the dispute process, visit: www.cms.gov/nosurprises or call 1-877-696-6775.

 Keep a copy of your “Good Faith Estimate” in a safe place or take pictures of it. You may need it if you are billed a higher amount.

Still have questions about the “Good Faith Estimate?” Please visit www.cms.gov/nosurprises for more guidance.

Any Other Questions?

Please get in touch with me for any additional questions you may have. I look forward to hearing from you!