Your Billing Rights: Good Faith Estimates and Surprise Medical Bills

Holistic Psychotherapy is a private-pay, out-of-network practice. Two protections under the federal No Surprises Act, which took effect January 1, 2022, may apply to you: your right to receive a Good Faith Estimate of expected charges, and protections against surprise or balance billing.

Your Right to Receive a Good Faith Estimate of Expected Charges

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

Under federal law, health care providers must give patients who do not have insurance, or who are not using insurance, an estimate of expected charges for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services, including psychotherapy sessions.
You will receive a Good Faith Estimate in writing when you schedule care at least three business days in advance. You may also request one at any time. You do not need to use the words "good faith" to ask for it.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill. A dispute must be started within 120 days of the date on your bill.
Keep a copy or a photo of your Good Faith Estimate so you can compare it with your final bill.

Because psychotherapy is ongoing rather than a single procedure, an estimate for counseling generally lists the per-session fee and the number of sessions expected over a defined period. If our plan changes — for example, moving from weekly to biweekly sessions, or adding family sessions — you can request an updated estimate at any time.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/medical-bill-rights.

Protection From Surprise Billing and Balance Billing

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.

About This Practice

Holistic Psychotherapy is an out-of-network outpatient practice and does not provide in-network services. We do not bill for any services outside of the agreed-upon services as outlined in the practice policies and informed consent documents. All clients of Holistic Psychotherapy are responsible for the cost of services at the time of the service. Should a client wish to use their insurance benefits for out-of-network coverage, the client is solely responsible for submitting the claim and receives payment directly from their insurance company.

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 co-payment, 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

Emergency Services

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 balance billed for these post-stabilization services.

Holistic Psychotherapy is an outpatient out-of-network practice and does not provide emergency 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 there 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, or hospitalist 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.

Additional Protections

When balance billing isn't allowed, you also have the following protections:

You are only responsible for paying your share of the cost — the co-payments, coinsurance, and deductibles that you would pay if the provider or facility were 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).
Your health plan generally must cover emergency services by out-of-network providers.
Your health plan generally must 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.
Your health plan generally must 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 the Georgia Secretary of State at https://sos.ga.gov/.

For more information about your rights under Federal law, visit the Centers for Medicare & Medicaid Services model disclosure notice at https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf.

Questions

If you have questions about fees, payment, or what to expect financially before beginning therapy, please ask. I am glad to talk it through before we start. Call 770-670-8849.