Notification of Federal Protections against Surprise Medical Bills for Out-of-Network clients
As of January 2022, there are new federal protections regarding certain circumstances for out-of-network billing. This is a notice of those federal protections. After the notification, you can read about how this may or may not impact your services with Blooming Minds Counseling.
Getting care from this provider or facility could cost you more (if we are out-of-network):
If you have insurance that Blooming Minds Counseling does not work with and choose to proceed working with Blooming Minds Counseling (you are choosing to not use your insurance in-network benefits), getting care from this provider or facility could cost you more than if you went to an in-network provider.
If your insurance plan covers the item or service you are getting, federal law protects you from higher bills:
Ask your healthcare provider or patient advocate if you need help knowing if these protections apply to you.
According to federal regulations, a waiver can be signed to pay the full fees, which may be more than your in-network benefits, which may mean you have:
You should not sign any waivers, if you did not have a choice of providers when receiving care. For example, a doctor was assigned to you with no opportunity to make a change (or without choice). Before deciding whether to sign a waiver, you can contact your health plan to find an in-network provider or facility. If there isn’t one, your health plan might work out an agreement with a provider or facility.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical 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 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 (in network rate) and the full amount charged (private fee) 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, deductible, 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 balance filed 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 these 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 are never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
For more information about your rights under federal law, visit:
Please note, when signing up for care at Blooming Minds Counseling, you always have a choice to engage in services or seek a provider outside of Blooming Minds Counseling. Blooming Minds Counseling does not provide emergency services, so any reference to balance billing and emergency services does not apply to our level of care. Additionally, clients will have already established their in-network status or their agreement for private pay or out-of-network status prior to engaging in any services, as a non-emergent care type. Therefore, clients who choose to engage in services with Blooming Minds Counseling are allowed, under federal regulations, to sign a waiver to proceed with private pay services at Blooming Minds Counseling’s full rate. Prospective clients have a right not to sign a waiver or not to agree to full fees for private pay or out of network billing, when establishing services, however, Blooming Minds Counseling has the right not to proceed with services at that time. Blooming Minds Counseling is not responsible for becoming in network with new insurance companies, please consider this before signing any waivers to engage in private pay care at Blooming Minds Counseling.
Blooming Minds Counseling accepts all in-network insurances. There is much to understand about pre-authorization of services, your deductible, co-payments, co-insurance, etc. We can assist in checking your mental health benefits, but we are not billing experts. It is ultimately up to you to contact your insurance company to check and make sure we are in network.
We are also in network with most Medicaid plans (United Healthcare Community Plan, BlueCare, WellPoint).
We are not in network with any Medicare networks at this time.
For individuals with out-of-network insurance, we are happy to supply you with a receipt for services that you may submit to your insurance for reimbursement.
Please call us with any questions regarding your insurance benefits or self-pay rates at (931) 386-6300.
COMMON INSURANCE TERMS
DEDUCTIBLE:
A deductible is the amount a member must pay out-of-pocket before insurance benefits kick-in. Deductibles are often listed annually, by individual and family. In other words, if you have a $300/$900 deductible, it means that $300 must be paid for an individual member OR $900 for the combined family before insurance will begin paying for services. Deductibles correspond to your plan's policy year (e.g. calendar or fiscal).
CO-PAYMENT/CO-INSURANCE:
A co-payment is the portion of the charge for the appointment that the member if responsible for. This amount may be a specific dollar amount, a percentage for the total charge, or a combination of the two.
PRE-AUTHORIZATION OF SERVICES:
Some plans require you, the member, to call in advance of your appointment to receive authorization for a covered service. Failure to obtain pre-authorization can result in the member being responsible for the entire fee for the service.
IN-NETWORK BENEFITS:
Many insurance plans have provider panels (professionals that are contracted with your insurance company), which are the professionals whose services the plan will pay the maximum benefit for.
OUT-OF-NETWORK BENEFITS:
Some plans allow members to "swing-out" of the panel and see any provider they choose. The main disadvantage of going outside your network is you may have to pay a higher deductible and/or copay than if you use a provider who is considered in-network.
INSURANCE VERIFICATION
Payment Options
Does Blooming Minds Counseling accept insurance?
Our clinic accepts most major insurance plans, including most plans by:
We are also in network with most Medicaid plans.
Blooming Minds Counseling cannot bill to and we are not in network with any Medicare plans at this time, even if they are associated with a company we are in network with, or if you have secondary insurance with a company we are in network with.
EAPs: Our supervised clinicians cannot accept any EAPs, and being in -network with an insurance company listed above does not guarantee EAP coverage with any of our providers. We work with very limited EAP plans.
Always check with your insurance to be sure that we are in network.
What is the benefit of using insurance?
The benefit to using insurance for therapy appointments is that your insurance offers you a discounted rate from our full private pay fee for therapy services.
Your insurance benefits will determine how much you will owe for your therapy sessions, based on the rates the insurance has set and your specific benefits.
Some insurances will cover therapy services 100% (Medical Assistance for example), and other plans will come with a co-pay, deductible, and/or co-insurance that clients will owe for therapy services.
What if I have more than one health insurance?
Many clients have multiple active insurance policies at one time and multiple policies are then responsible for your therapy coverage. Please note that clients cannot pick and choose which insurance policy they would prefer to use at any given time. Insurance companies determine which insurance is primary, secondary, and so on. We are required to follow the policy order for claim submission and therefore must be aware of all policies that are active for our clients. We appreciate your understanding!
What if my insurance coverage ends or changes?
If insurance coverage ends at any time, clients will become financially responsible for therapy services engaged after coverage ends.
Clients are responsible for providing up-to-date insurance information 1 week prior to all therapy appointments in order to use insurance benefits.
If insurance changes and that new information is not provided prior to the appointment, clients will be fully financially responsible for therapy services that occurred prior to notification.
Clients are additionally fully financially responsible for any missed appointments and late canceled appointments.
This is outlined in our Policies.
What if I want to pay out of pocket or you are Out of Network with my insurance?
Our clinic accepts private pay clients in addition to clients with the insurances listed above. Our private pay rates and all associated rates are listed here.
Our policies state that clients who are not covered under insurance are fully responsible for all therapy costs at the time of service. Clients who do not have insurance, are out of network, or are choosing not to use their benefits, may additionally be asked to sign a waiver related to their specific situation, as required by federal guidelines or insurance contracts if opting out of insurance benefits.