Beginning January 1, 2022, federal laws regulating client care have been updated to include the “No Surprises” Act (outlined below.) This Act requires health care practitioners to provide current and potential clients a “Good Faith Estimate” (GFE) on the cost of treatment.
This new regulation is designed to provide transparency to patients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills. It allows patients to understand how much their health care will cost before they receive services.
There are a number of factors that make It challenging to provide an estimate on how long it will take for a client to complete therapeutic treatment, and much depends on the individual client and their goals in seeking therapy. Some clients are satisfied with a reduction in symptoms while others continue longer because it feels beneficial to do so. Others begin to schedule less frequently, and may continue to come in for “tune ups” or when issues arise. Ultimately, as the client, it is your decision when to stop therapy.
When we meet, I will verbally provide you with a Good Faith Estimate (GFE). In addition, this estimate will be available to you in writing either through the client portal. I have provided here my current session fees, projected for a 12 month period with differing levels of sessions scheduled. I will update the GFE estimate should my session fees change. This estimate is not a contract and does not bind either of us to continue sessions.
Good Faith Estimate Details for Individuals
1 Individual 60 minute session: $120
1 Session monthly for 12 months: $1440
2 Sessions monthly for 12 months, with 2 weeks off, (22 Sessions): $2640
Weekly Sessions for 12 months with 4 weeks off (48 Sessions): $5760
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 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 providersmay 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 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 facilitymay bill you is your plan’s in-
network cost-sharing amount (such as copayments 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 balanced
billed 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 those 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’re never required to give up your protections from balance billing. You also
aren’t required to get care out-of-network. You can choose a provider or facility
in your plan’s network.
When balance billing isn’t allowed, you also have the following
protections:
• You are only responsible for paying your share of the cost (like the copayments,
coinsurance, and deductibles that you would pay if the provider or facility was in-network).
Your health plan will pay out-of-network providers and facilities directly.
If you believe you’ve been wrongly billed, you may contact https://www.cms.gov/nosurprises OR New York State Department of Financial Services.
Visit https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills for more information about your rights under federal law.
Under this law the following individuals are entitled to a Good Faith Estimate of Costs
The Good Faith Estimate does not include all costs that you may incur during the course of treatment with Sacha M Sanger - LMHC which are in addition to direct counseling services and fees. These fees may occur due to the following (not an exhaustive list):
This new regulation is designed to provide transparency to patients regarding their expected medical expenses and to protect them from surprises when they receive their medical bills. It allows patients to understand how much their health care will cost before they receive services.
There are a number of factors that make It challenging to provide an estimate on how long it will take for a client to complete therapeutic treatment, and much depends on the individual client and their goals in seeking therapy. Some clients are satisfied with a reduction in symptoms while others continue longer because it feels beneficial to do so. Others begin to schedule less frequently, and may continue to come in for “tune ups” or when issues arise. Ultimately, as the client, it is your decision when to stop therapy.
When we meet, I will verbally provide you with a Good Faith Estimate (GFE). In addition, this estimate will be available to you in writing either through the client portal. I have provided here my current session fees, projected for a 12 month period with differing levels of sessions scheduled. I will update the GFE estimate should my session fees change. This estimate is not a contract and does not bind either of us to continue sessions.
Good Faith Estimate Details for Individuals
1 Individual 60 minute session: $120
1 Session monthly for 12 months: $1440
2 Sessions monthly for 12 months, with 2 weeks off, (22 Sessions): $2640
Weekly Sessions for 12 months with 4 weeks off (48 Sessions): $5760
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 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 providersmay 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 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 facilitymay bill you is your plan’s in-
network cost-sharing amount (such as copayments 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 balanced
billed 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 those 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’re never required to give up your protections from balance billing. You also
aren’t required to get care out-of-network. You can choose a provider or facility
in your plan’s network.
When balance billing isn’t allowed, you also have the following
protections:
• You are only responsible for paying your share of the cost (like the copayments,
coinsurance, and deductibles that you would pay if the provider or facility was in-network).
Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an
- in-network provider or facility and show that amount in your explanation of
- benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact https://www.cms.gov/nosurprises OR New York State Department of Financial Services.
Visit https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills for more information about your rights under federal law.
Under this law the following individuals are entitled to a Good Faith Estimate of Costs
- Individuals with no insurance coverage.
- Individuals enrolled in individual or group health insurance coverage but not seeking to have a claim submitted to the insurance plan for coverage AND the provider/practice is not in-network.
The Good Faith Estimate does not include all costs that you may incur during the course of treatment with Sacha M Sanger - LMHC which are in addition to direct counseling services and fees. These fees may occur due to the following (not an exhaustive list):
- Late cancellation/no show fee
- Medical records request
- Completion of documents (FMLA, disability, summary letters, etc)
- Court related fees
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