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Navigating Health Insurance can be extremely overwhelming! Our goal is to make this process as smooth as possible. When you call to schedule your first appointment with us, our intake staff will gather your insurance information over the phone and call your insurance plan to verify your mental health benefits prior to scheduling your appointment. This ensures the most up to date benefit information possible so you know exactly what to expect for payment for services.
You will be asked to complete paperwork, bring your insurance card and driver’s license to make a copy for your chart, and place a credit card on file. Our office will file all claims for you, on your behalf, and you will be responsible for any co-payment, co-insurance or payment towards your deductible at the time of service.
No Surprises Act
Effective January 1, 2022, the No Surprises Act, which Congress passed as pat of the Consolidated Appropriations Act of 2021, is designed to protect clients from surprise bills for emergency services at out-of-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured clients to receive a good faith estimate of the cost of care.
Overview
Surprise billing occurs when clients receive care from out-of-network providers without their knowledge. Surprise billing therefore results in higher costs for medical services that would have been cheaper if rendered by providers inside their health plan’s network. This can happen when someone involved in the client’s care is not in-network. The rule is intended to cut down on surprise costs, and also to ban out-of-network charges without notice in advance (providing plain-language consumer notice).
Consumer Notice
Requiring out-of-network providers to provide any of our potential clients with notice that they are outside of the client’s health plan’s network is a large part of the No Surprises Acts purpose. Any potential client can waive paying out-of-network prices for non-emergency services so long as they consent. We have a standard notice that can be given to out-of-network clients when they seek services, which must be given to clients within seventy hours of the scheduled appointment or service (or within three hours for same-day services). At your request, we will provide this notice to you in paper or electronic format, as you prefer, and you will receive a copy. The form will clearly state:
o The provider (or our facility) is out-of-network
o An estimate of the cost of our services (which we will calculate in good faith)
This document will be separate from all other documents you sign prior to care. We will provide it in additional languages if requested.
You are never required to give up your protections from surprise billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan’s network.
Lastly, there is a requirement that states that out-of-network providers must notify health plans when they provide a client service, and they must certify that they have met the required notice and consent requirements. We will keep these records for a minimum of seven years.
If You Think You Have Been Wrongly Billed or Have More Questions
If you think you have been wrongly billed or are uncertain whether the No Surprises Act applies to you or if you have any additional questions about standard notice forms of the No Surprises Act in general, please contact us.
Complaints
If you still feel you have been wrongly billed, complaints may be directed to our billing department at 815-941-3882 or to the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/nosurprises/consumers or 800-985-3059.
No Show/Late Cancellation Policy ($65 therapist/$50 doctor charge)
Cancellations and Missed Appointments
The client is expected to attend each scheduled session on time. A canceled or delayed appointment delays our work and can negatively impact other clients. Since your appointments involve the reservation of a time specifically for you, and out of respect for your therapist/doctor and our other clients, a minimum of 24 hours’ notice is required for rescheduling or cancelling an appointment. We appreciate more than 24 hours’ notice when possible, as we can make that time available for someone else. PLEASE contact your clinician or the office at 815-941-3882 to notify of any cancellations and/or rescheduling.
Waiving No Show/Late Cancellation
The only exception to this cancellation policy is in the event of a serious or contagious illness or emergency. We offer one grace for these purposes every six months. Some examples of emergencies are car accidents, deaths in the family or extreme illnesses. Please keep in mind that we can swap your in-person session for a telehealth session which can be very convenient in the event of less emergent situations that would otherwise cause an appointment cancellation.
Frequent Cancellations or Missed Appointments
Frequent cancellations or missed appointments (3 or more in six months, or 2 consecutives) will result in termination of treatment.
Also, please keep in mind that although Crossroads Counseling Services PLLC will send reminder texts/phone calls/voice mail messages, this is done as a courtesy and only if you consent to receive such communications. It remains your sole responsibility to keep track of and timely attend all scheduled therapy/doctor appointments, whether or not you receive the reminder.
Medicaid Clients
Please note that the fees described in this policy cannot be applied to Medicaid insurances (including Medicaid managed plans, i.e. Blue Cross/Blue Shield Community, Aetna Better Health, and Meridian). Thus, clients with these Medicaid insurances who have three or more late cancellations or missed sessions will be referred out to another provider.
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