NO SUPRISES ACT: What is it and how does it impact my care?

Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the "No Surprises Act" which requires practitioners to provide a "Good Faith Estimate" about out-of-network care. The Good Faith Estimate works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for therapy. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new "Good Faith Estimate" should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your therapist have not previously talked about the change and you have not been given an updated good faith estimate. Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care items and services to receive a "Good Faith Estimate" of expected charges.

Note:

The PHSA and GFE does not currently apply to any clients who are using insurance benefits, including "out of network benefits'' (i.e., submitting superbills to insurance for reimbursement).

Timeline requirements:

Practitioners are required to provide a good faith estimate of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.

That estimate must be provided within specified timeframes:

  • If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;

  • If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling;

  • If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the client reschedules the requested item or service.

Good Faith Estimate Disclaimer

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may 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 there is financial assistance available. You may also 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 4 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 with you, you will have to pay the price on this 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 process, go to www.cms.gov/nosurprises or call 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Keep a copy of this Good Faith Estimate in a safe place.

This Notice is effective on 1/1/2022.

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS (OMB Control Number: 0938-1401)

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 healthcare 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 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 there may be out-of-network. In these cases, the most that 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 or for more information about your rights under Federal law, you may visit: www.cms.gov/nosurprises or call 1-800-985-3059.

Contacting Jennifer L. Hillier

Counselor: Jennifer L. Hillier M.A. LPC & CCTP1

Practice Location: North New Braunfels Ave. Suite 538,

San Antonio, Texas 78217

Phone: 210-895-4315 Fax: 210-899-1415

Hours of operations are Monday through Friday from 8:00 AM–5:00 PM. Our voices mails are not monitored. If you are experiencing a crisis, please call 911. Counselor Jennifer L. Hillier does not provide medical emergencies. Your call is very important. If you are unable to reach me by phone please leave me an email or text message with the following information: Your first and last name. Contact Information, Email address, and Reason for calling

Health Insurance & Medicaid Benefits Accepted

In Network Health Insurance Provider Accepted: Ambetter, Ameri-group, BCBS, Beacon, Health Smart, Humana Military, OPTUM Health, Molina, Multi-plan, Superior Health Plan, Texas Medicaid, United Health Care.

EAP: BHS Accepted

PLEASE CONTACT US TO ENSURE WE ACCEPT YOUR INSURNACE BENEFITS; AS THIS IS SUBJECT TO CHANGE WITHOUT NOTICE!

How to Utilize Your Out of Network Benefits

Guide to Understanding Your Out of Network Health Insurance Benefits

ONN “out-of-network benefits” or coverage means that if you want to see a provider that is not in your insurance company’s network, your insurance may provide partial or total coverage. Each health insurance plan is different, the best way to determine if you have out-of-network benefits is to call and speak with a benefits representative at your insurance company directly. The representative you speak with should be able to explain the details of your plan, as well as provide you with necessary instructions to use your benefits. I encourage you to have something to write with to document the date, representative’s name with ID number, and call confirmation number. This will also be helpful in case we need to appeal or challenge a claim. Sometimes there are different providers for behavioral health and medical care existing under one insurance plan who may oversee your mental health benefits. Please keep in mind that you may have to call to confirm the which provider manage your behavioral health benefits if your insurance card does not show it. You will find contact information needed on the back of your insurance card.

REQUESTING INFORMATION ABOUT YOUR COVERAGE.

Ask the benefit’s representative to explain what your out-of-network benefits are. Is there a deductible, or is there an annual visit maximum amount? Ask the representative to confirm the requirements to use out-of-network benefits. For example, they may insist you pay the full fee out-of-pocket, and then submit a completed Health Insurance Claim Form (Superbill). In this case, you would receive the reimbursement check directly. It is also important to confirm the processing time once a claim form or invoice is submitted, so you can plan accordingly. If your plan is a HMO (Health Maintenance Organization) they may have more in-depth requirements to go outside of the network, and want to pay me directly. Again, each plan is different. Take detailed notes, do not hesitate to ask clarifying questions, and feel free to contact me for any help along the way. Once you understand your benefit options and how to use them, please email me all the requirements at jennifer@mending-hearts.com.

Private Pay

Thinking of starting counseling but in need to of complete anonymity due to your identity or professionalism?

Online counseling can provide the privacy and confidentiality you are looking for. For some individual, their social status in the family, community, and career may requires anonymity to maintain the status quo, avoid stigmatization, personal reasons, preserve reputations, and/or for clearance qualifications needed to maintain employment.

The Benefits of Utilizing Private Pay for Counseling:

Provides the highest standard of privacy and confidentiality for individual needing anonymity. Ability to select the professional who is best suited for you and your family needs. Eliminates requirements to share your personal health information with a third party. There are no set limitations on the number of visits you can schedule with your counselor. Choose the focus, length, and frequency of therapy. Most importantly, there is no mandatory requirement for mental health diagnosis. While insurance can be an affordable option, high deductible can make it unaffordable. Private pay may be more cost effective.

Counseling Session Rate:

Individual Intake Assessment (50 minutes) $180.00

Individual Counseling Session (50 minutes) $150.00

Couple Intake Assessment (50 minutes) $230 .00

Couple Counseling Session (50 minutes) $200.00

Cancellation and Refunds

APPOINTMENT CANCELLATION POLICY:

A minimum 48 hour notice for cancellation is required. Mending-hearts reserve the right to charge you the full session rate if you have given us less than 48 hours notice. I understand that sometimes cancelling a session is unavoidable. Please contact us to explain the situation. Mending-hearts is not inclined to charge you for missing a session, as long as, you have tried to contact us, as soon as possible. I ask you to give us as much notice as possible in order for us to allocate the session to someone else. If I am unable to allocate the session, you will be charged the full session rate.

REFUND POLICY:

All appointment cancelled 48 hours before appointment will be fully refunded. Please allow 7 business days to process your request. There are circumstances in which it is not possible to give a 48 hour notice. In certain events. We have the options at our discretion to reschedule your appointment at a later time if you were not able to cancel your appointment within the 48 hour window. This option is typically for emergency only with verified documentation.

Appointment Availability

Counseling and Therapy Services provides online counseling and therapy services for all residents in Texas. Appointment are available Monday - Friday from 8:00 am to 4:00 pm. Limited evenings appointments are available from 5:00 to 7:00 pm. Weekend Saturday and Sunday appointment are available.


Accepting New Clients: Yes, we are currently accepting new client ages 12 years old and up.

Online Counseling (Telehealth): Currently only seeing client online for counseling services.

Face to Face: Currently at this time we are not seeing clients face to face

In-housing Counseling: Currently at this time we are not seeing client in their home.