What is no surprise billing?

Beginning in January 2022, the Public Health Services Act, a new federal law, requires Health Care Providers to provide information about rights and protections to help prevent surprise and unexpected billing.  Many have experienced the shock of medical bills following a trip to the ER, surgery, or other medical procedure.  Since therapists/counselors are considered Health Care Providers, we are included in this effort to prevent surprise billing.

Keep in mind that overall therapy/counseling costs cannot be estimated like a surgical or other medical procedure. The number of sessions of your work in counseling depends on many factors to be evaluated collaboratively between you and your therapist.  The best we can do is to inform you of session fees and help educate about possible insurance benefits.

Cash Billing

 Cash billing is used when you are paying for your counseling services with cash, check, or credit card and are not attempting to file insurance claims.   Sometimes licensed therapists do not file claims.  You as a client might not want to file insurance claims because you do not want a mental illness diagnosis on your medical record.

When paying cash for services, the billing at WHC is simple.  You just pay the counselor’s fee for each session conducted.  There are no surprises or hidden fees.  In some cases where a client expresses financial hardship, a therapist is free to reduce his or her fee to accommodate the hardship. This results in a Net Session Fee. Any reduction of this kind is discussed and agreed to between therapist and client.  There are no surprises here. With insurance involved, this gets more complicated. Keep in mind that your therapist has only one fee for any given service. The Net Session Fee is the maximum your therapist will charge you for a session due to your hardship reduction. See the “Sample Good Faith Estimate” for more clarification.

*At WHC we will ask you to keep a credit card on file for billing purposes in our electronic billing system. Payment is due at the time of service. You have the option to be put on an auto-pay system, where your card is automatically charged eached night electronically or you can manually pay yourself within the portal system.

Fees

• Licensed Therapists: $150
• Couples Counseling: $150
• Telehealth: $150
• Temp-licensed: $140
• Master’s Level: $125

Good Faith Estimate

The Staff at WHC will clarify our general fee during your intake call(s) and can verify insurance benefits upon request.  If you have asked us to verify benefits for you we will provide a follow up email with a  clear statement of the fee and any hardship fee reductions; and whether your therapist qualifies to file insurance claims. This estimate is not a contract.  You may choose to not see the therapist or switch to another therapist at any time.

The WHC Insurance team will attempt to verify your insurance benefits.  If you have benefits, they will attempt to file claims and track posting of payments along with your co-insurance payments.  We make no promise of any coverage from your insurance company, and you are responsible for any of the fees they do not pay.  If you have paid, and then your insurance company pays on the same sessions, you can use the credit for future sessions, or you can request a refund.  If you are finished with your counseling work and have a credit balance, we will issue a refund to you in a timely fashion.

Your Rights

Though we would love to help with your counseling needs, you are not required to see our therapists.  You have freedom to seek in-network therapists through your insurance company if you want.  Your out-of-pocket expenses will likely be lower than out-of-network therapists except interns and therapists who lower their fee to accommodate hardship.

Though WHC does not provide billed emergency services, you should be aware that agencies, hospitals, or providers who do provide emergency services are no longer allowed to collect fees beyond in-network rates from you.

If you think you have been wrongly billed at WHC, contact Molly O’Brien at molly@withinholisticcounseling.com or 865-297-5077 or Jamie Padgett at JamiePadgettMedicalBilling@gmail.com  or 865-404-3469.   We will be happy to listen and resolve the issue.  You can also visit www.CMs.gov/nosurprises/consumers for information about your rights under Federal Law.  If you believe you have not gotten resolution with WHC administration, you can call 865-297-5077 for information and to make a complaint. We certainly hope to avoid that and will work with you to get the issue resolved.