2022 Fees & Info on the No Surprises Act 


As of January 1, 2022, for folks who do not have insurance, my fee schedule will operate on a tier system. I believe in creating space where folks who cannot afford to pay are not penalized or unable to access therapy. In order for me to hold space for some folks who cannot pay or who need to be drastically reduced fees (I keep 5 such spots at any given time), the following is the tier system.
1: Ability to Give Back and Redistribute Funds
This tier is for folks who have financial means and can afford to buffer the costs for those in financial hardship. Payment at full tier means that I can sustain this work and offer deep discounts when people are in financial straits.
Intake: $150    Each 50-Min Session after: $125
2. Tier 2
This tier is for folks who can afford moderate pricing for therapy services and may or may not have insurance that they aren’t using.
Intake: $125    Each 50-Min Session After: $100
3. Tier 3
This tier is for folks who are employed, ideally making a living wage, and can afford to pay for services out of pocket but cannot afford either of the above options.
Intake: $90   Each 50- Session: $75

Insurance Policies


I am currently in-network with the following insurance companies.

  • Magellan
  • Behavioral Health Systems
  • American Behavioral
  • Medicare
  • Optum/United Healthcare

I have terminated with Bluecare, effective 1/1/2022. My contract with BlueCross/BlueShield of TN will expire on 5/1/2022. I have also elected to terminate with Cigna effective 1/14/2022. I understand this can create hardships for folks. If you would like to advocate for providers to be paid better which would encourage more providers to retain contracts with insurance providers, please contact your insurance provider directly to advocate.

Please note, being in-network with an insurance company does not mean they will reimburse session fees as required for payment. Any deductibles and benefits to be paid are the responsibility of the patient.

You can choose NOT to use your insurance benefits UNLESS you have Bluecare or any other state funded medicaid (Amerigroup or UHC-Community Plan), then you must file an insurance benefit.

Forms of Payment


Cash, Check, Credit/Debit cards (via Square or Stripe), FSA, HSA

 

The No Surprises Act of 2022 Disclosure

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE

 MEDICAL BILLS

(OMB Control Number: 0938-1401)

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatorysurgical 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 treatedby 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 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 tobe balance billed.

 

If you get other services at these in-network facilities, out-of-network providers can’t balance  bill you unless yougive 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
  • Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (priorauthorization).
  • Cover emergency services by out-of-network
  • 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
  • Count any amount you pay for emergency services or out-of-network services toward yourdeductible and out-of-pocket

If you believe you’ve been wrongly billed, you may contact: The Department of Health Related Boards

10 James Robertson Parkway, Nashville, TN 37243 tn.health@tn.gov

Visithttps://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.