PAYING FOR TREATMENT

There are a variety of ways to pay for treatment. The following sections describe various ways of paying for treatment: 

 

-Health Insurance Coverage: Many people are covered by the health insurance policies of their employers. If you receive health insurance from your employer, I may be an "in-network" provider with your insurance company. That means I have entered into a contract to provide services to persons who are covered by their insurance (also called "members"- which would be you). I am a credentialed in-network provider with the following insurance companies:

  • Cigna

  • Community Care Behavioral Health (CCBH)

  • Geisinger

    • HMO/PPO/POS​

    • Third-Party Administrator (TPA)

    • PA CHIP

    • Medicare Advantage

    • Marketplace/Exchange Products

  • Highmark Blue Shield- (Premier Blue Specialist) includes the following networks:

    • ACA Select

    • Performance Blue

    • Premier Blue Shield

    • Preferred Provider Organization (PPO)

    • First Priority Health HMO

  • Medicare Part B

  • Optum Health Plan

-Out-of-Network: This is for those persons who have insurance, but not one of the insurances listed above. Under this arrangement, I will provide you with any documentation that you may need to request reimbursement from your insurance company, including payment receipts. You pay for the session and then request reimbursement from your insurance company. You are encouraged to discuss this option with your insurance company prior to beginning services, as, under this arrangement, the insurance company may not provide you with the full reimbursement amount (that is, they may not reimburse you the full amount that you paid for services). 

-Out-of-Pocket: This payment arrangement is for those persons who do not have insurance, or would prefer not to use their insurance benefit to pay for services. Under this arrangement, you pay for services at the time services are rendered. My private pay rates range from $150-$200/hour, depending on the service(s) provided. 

If you don't think you can afford treatment, please contact me; I  offer some limited pro-bono work and a sliding scale for people experiencing financial challenges. 

No Surprises Act

The "No Surprises Act" (NSA) is part of the Consolidated Appropriations Act of 2021, which went into effect on January 1, 2022. This legislation purports to protect patients from unexpected medical bills.

This new legislation requires all health care facilities and providers to give a good faith estimate (GFE) of the likely costs of proposed treatment PRIOR to the treatment taking place. GFEs are required to be provided to uninsured/self-pay patients. While the NSA does have provisions to require GFEs to be provided to insurance companies, this provision of the NSA is not currently active. 

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 GFE. 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/consumers or call 1-800-985-3059.

 

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.

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