counseling Therapy Fees

You are protected from surprise billing or 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. 

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,  such as a copayment, coinsurance, and a deductible. You may have additional charges or 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 project agreed to pay and the total 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 schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. 

Emergency services: 

Suppose you have an emergency medical condition and get emergency services from an out-of-network provider or facility. In that case, 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 balanced 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. 

Specific 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.

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles 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). 

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 or out-of-network services toward your deductible and out-of-pocket limit. 

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.