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 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 treated by an out-of-network provider.

You are protected against emergency billing and surprise billing in certain circumstances, such as emergency care provided in a hospital setting. Since I am an out-of-network provider who provides non-emergency services (i.e., I treat individuals on an out-patient basis), I may charge more than your insurance allows for a service (i.e., engage in balance billing). We will discuss my fees and your care prior to your first appointment.

I am required to provide you with an estimate of the fee, based on a general estimate of the number of sessions required to treat your condition. Due to factors outside of my control (e.g., your engagement with treatment, unknown life circumstances that neither you nor I can predict), it is difficult to predict with accuracy the total cost of psychotherapy. Therefore, my estimate will be based on the number of sessions I anticipate providing in a year and my rate for psychotherapy. I will also provide you with a table of fees for additional services, should you need care outside of our scheduled sessions.

For assessment services, I will provide you a general range of hours I anticipate your assessment will take. Because I cannot know in advance if more testing will be needed to answer your specific assessment question without evaluating you, I will notify you if I believe more testing (and more hours of time) will be required to answer your referral question.