Many plans offer out-of-network benefits where insurance will pay a portion of the session. If you’d like to utilize your out-of-network benefits for sessions please contact the number found on the back of your card to find out reimbursement. You will be responsible for the full fee at the time of the appointment and I can provide you with a super bill to submit to insurance for reimbursement.
We are unable to submit claims directly to insurance plans we are not in network with.
We do not verify benefits
Clients are responsible for the cost of services rendered
If you do not have insurance, please contact us about our accessible and affordable self pay rate. Send us a note at email@example.com
Self Pay (no insurance) Fees
Insurance Fees (both in and out of network)
Late Cancellation Policy Fee (under 24 hours notice)
No Show Policy (Does not show up), you will be charged the full fee for your session.
*Fees updated as of Jan 1st 2023
We unfortunately do not accept Medicare, Medicaid, or other state programs.
Participamos en la red con la mayoría del seguro médico de Blue Cross Blue Shield PPO y Blue Choice.
Muchos planes ofrecen beneficios fuera de la red donde el seguro pagará una parte de la sesión. Si desea utilizar sus beneficios fuera de la red para las sesiones, comuníquese con el número que se encuentra en el reverso de su tarjeta para averiguar el reembolso. Usted será responsable de la tarifa completa en el momento de la cita y puedo proporcionarle una factura para que la envíe al seguro para obtener un reembolso.
Si no tiene seguro, comuníquese con nosotros acerca de nuestra tarifa. Envíenos una nota a firstname.lastname@example.org
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
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:
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 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: www.cms.gov/nosurprises/consumers
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.