Resources
Common Questions
A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:
Attaining a better understanding of yourself, your goals and values
Developing skills for improving your relationships
Finding resolution to the issues or concerns that led you to seek therapy
Learning new ways to cope with stress and anxiety
Managing anger, grief, depression, and other emotional pressures
Improving communications and listening skills
Changing old behavior patterns and developing new ones
Discovering new ways to solve problems in your family or marriage
Improving your self-esteem and boosting self-confidence
A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:
Attaining a better understanding of yourself, your goals and values
Developing skills for improving your relationships
Finding resolution to the issues or concerns that led you to seek therapy
Learning new ways to cope with stress and anxiety
Managing anger, grief, depression, and other emotional pressures
Improving communications and listening skills
Changing old behavior patterns and developing new ones
Discovering new ways to solve problems in your family or marriage
Improving your self-esteem and boosting self-confidence
Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you’ve faced, there’s nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting where you’re at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.
People have many different motivations for coming to psychotherapy. Some may be going through a major life transition (unemployment, divorce, new job, etc.), or are not handling stressful circumstances well. Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, addictions, relationship problems, spiritual conflicts and creative blocks. Therapy can help provide some much needed encouragement and help with skills to get them through these periods. Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life. In short, people seeking psychotherapy are ready to meet the challenges in their lives and ready to make changes in their lives.
Because each person has different issues and goals for therapy, therapy will be different depending on the individual. In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session. Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or your desire for more personal development. Either way, it is most common to schedule regular sessions with your therapist (usually weekly).
It is important to understand that you will get more results from therapy if you actively participate in the process. The ultimate purpose of therapy is to help you bring what you learn in session back into your life. Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process – such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.
It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness. Working with your medical doctor you can determine what’s best for you, and in some cases a combination of medication and therapy is the right course of action.
To determine if you have mental health coverage through your insurance carrier, the first thing you should do is call them. Check your coverage carefully and make sure you understand their answers. Some helpful questions you can ask them:
- What are my mental health benefits?
- What is the coverage amount per therapy session?
- How many therapy sessions does my plan cover?
- How much does my insurance pay for an out-of-network provider?
- Is approval required from my primary care physician?
Confidentiality is one of the most important components between a client and psychotherapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist’s office. Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone. This is called “Informed Consent”. Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (your Physician, Naturopath, Attorney), but by law your therapist cannot release this information without obtaining your written permission.
However, state law and professional ethics require therapists to maintain confidentiality except for the following situations:
* Suspected past or present abuse or neglect of children, adults, and elders to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.
* If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threated to harm another person.
Do you have more questions?
Schedule a call or send us an email!
Resources & Links
Addiction & Recovery
Associations & Institutes
American Academy of Child & Adolescent Psychiatry
American Association for Marriage and Family Therapy
American Counseling Association
American Psychiatric Association
American Psychological Association
Association for Psychological Science
Canadian Mental Health Association
Center for Mental Health Resources
National Institute of Mental Health
Mental Health America
Substance Abuse and Mental Health Services Administration
Child Abuse & Domestic Violence
Depression
Diagnosis
Eating Disorders
Medications and Health Supplements
Mental Health Care General Links
Personality Disorders
Additional Mental Health Care & Counseling Resources
Anxiety Disorders
Attention-Deficit Hyperactivity Disorder
Chronic Fatigue
Developmental Disorders
Dissociation and Traumatic Stress
Journals & Magazines
ADHD Report
Anxiety, Stress and Coping
Autism
Childhood
Contemporary Hypnosis
Dementia
Depression and Anxiety
Drug and Alcohol Review
Dyslexia
Early Child Development and Care
Eating Disorders
Educational Assessment
Journal of Gambling Studies
Journal of Happiness Studies
Journal of Mental Health and Aging
Journal of Sex & Marital Therapy
Journal of Sport and Exercise Psychology
Journal of Substance Abuse Treatment
Language and Cognitive Processes
Loss, Grief & Care
Mental Retardation and Developmental Disabilities
Metaphor and Symbol
Neuropsychological Rehabilitation
Parenting
Personal Relationships
Personality and Individual Differences
Psychiatric Bulletin
Psychology of Men & Masculinity
Psychology Today
Stress and Health
Substance Abuse
Trauma, Violence & Abuse
Suicide Awareness and Hotlines
Note: Not responsible for the content, claims or representations of the listed sites.
Ready to book a session?
Schedule a call or send us an email!
Hot Topics
Sexual Abuse in Military Veterans
Military veterans experience a great deal of mental health conditions due to the traumatic environment that they are exposed too, during training and in combat.
How to find a therapist?
Most of us have heard of the saying “One size fits allâ€, but when it comes to mental health and shopping for a therapist this
We All Have Mental Health
Collectively as a society, we should prioritize normalizing mental health and mental illness in a way that it is as equally important as our physical
Do you have more questions?
Schedule a call or send us an email!
Legal Notice
(OMB Control Number: 0938-1401)
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 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 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 protection 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: www.cms.gov/nosurprises/consumers
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
(OMB Control Number: 0938-1401)
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 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 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 protection 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: www.cms.gov/nosurprises/consumers
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
Click HERE to read the full policy.
Ready to book a session?
Schedule a call or send us an email!
Common Questions
A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:
Attaining a better understanding of yourself, your goals and values
Developing skills for improving your relationships
Finding resolution to the issues or concerns that led you to seek therapy
Learning new ways to cope with stress and anxiety
Managing anger, grief, depression, and other emotional pressures
Improving communications and listening skills
Changing old behavior patterns and developing new ones
Discovering new ways to solve problems in your family or marriage
Improving your self-esteem and boosting self-confidence
A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:
Attaining a better understanding of yourself, your goals and values
Developing skills for improving your relationships
Finding resolution to the issues or concerns that led you to seek therapy
Learning new ways to cope with stress and anxiety
Managing anger, grief, depression, and other emotional pressures
Improving communications and listening skills
Changing old behavior patterns and developing new ones
Discovering new ways to solve problems in your family or marriage
Improving your self-esteem and boosting self-confidence
Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you’ve faced, there’s nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting where you’re at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.
People have many different motivations for coming to psychotherapy. Some may be going through a major life transition (unemployment, divorce, new job, etc.), or are not handling stressful circumstances well. Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, addictions, relationship problems, spiritual conflicts and creative blocks. Therapy can help provide some much needed encouragement and help with skills to get them through these periods. Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life. In short, people seeking psychotherapy are ready to meet the challenges in their lives and ready to make changes in their lives.
Because each person has different issues and goals for therapy, therapy will be different depending on the individual. In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session. Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or your desire for more personal development. Either way, it is most common to schedule regular sessions with your therapist (usually weekly).
It is important to understand that you will get more results from therapy if you actively participate in the process. The ultimate purpose of therapy is to help you bring what you learn in session back into your life. Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process – such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.
It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness. Working with your medical doctor you can determine what’s best for you, and in some cases a combination of medication and therapy is the right course of action.
To determine if you have mental health coverage through your insurance carrier, the first thing you should do is call them. Check your coverage carefully and make sure you understand their answers. Some helpful questions you can ask them:
- What are my mental health benefits?
- What is the coverage amount per therapy session?
- How many therapy sessions does my plan cover?
- How much does my insurance pay for an out-of-network provider?
- Is approval required from my primary care physician?
Confidentiality is one of the most important components between a client and psychotherapist. Successful therapy requires a high degree of trust with highly sensitive subject matter that is usually not discussed anywhere but the therapist’s office. Every therapist should provide a written copy of their confidential disclosure agreement, and you can expect that what you discuss in session will not be shared with anyone. This is called “Informed Consent”. Sometimes, however, you may want your therapist to share information or give an update to someone on your healthcare team (your Physician, Naturopath, Attorney), but by law your therapist cannot release this information without obtaining your written permission.
However, state law and professional ethics require therapists to maintain confidentiality except for the following situations:
* Suspected past or present abuse or neglect of children, adults, and elders to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.
* If the therapist has reason to suspect the client is seriously in danger of harming him/herself or has threated to harm another person.
Do you have more questions?
Schedule a call or send us an email!
Resources & Links
Addiction & Recovery
Associations & Institutes
American Academy of Child & Adolescent Psychiatry
American Association for Marriage and Family Therapy
American Counseling Association
American Psychiatric Association
American Psychological Association
Association for Psychological Science
Canadian Mental Health Association
Center for Mental Health Resources
National Institute of Mental Health
Mental Health America
Substance Abuse and Mental Health Services Administration
Child Abuse & Domestic Violence
Depression
Diagnosis
Eating Disorders
Medications and Health Supplements
Mental Health Care General Links
Personality Disorders
Additional Mental Health Care & Counseling Resources
Anxiety Disorders
Attention-Deficit Hyperactivity Disorder
Chronic Fatigue
Developmental Disorders
Dissociation and Traumatic Stress
Journals & Magazines
ADHD Report
Anxiety, Stress and Coping
Autism
Childhood
Contemporary Hypnosis
Dementia
Depression and Anxiety
Drug and Alcohol Review
Dyslexia
Early Child Development and Care
Eating Disorders
Educational Assessment
Journal of Gambling Studies
Journal of Happiness Studies
Journal of Mental Health and Aging
Journal of Sex & Marital Therapy
Journal of Sport and Exercise Psychology
Journal of Substance Abuse Treatment
Language and Cognitive Processes
Loss, Grief & Care
Mental Retardation and Developmental Disabilities
Metaphor and Symbol
Neuropsychological Rehabilitation
Parenting
Personal Relationships
Personality and Individual Differences
Psychiatric Bulletin
Psychology of Men & Masculinity
Psychology Today
Stress and Health
Substance Abuse
Trauma, Violence & Abuse
Suicide Awareness and Hotlines
Note: Not responsible for the content, claims or representations of the listed sites.
Ready to book a session?
Schedule a call or send us an email!
Hot Topics
Sexual Abuse in Military Veterans
Military veterans experience a great deal of mental health conditions due to the traumatic environment that they are exposed too, during training and in combat.
How to find a therapist?
Most of us have heard of the saying “One size fits allâ€, but when it comes to mental health and shopping for a therapist this
We All Have Mental Health
Collectively as a society, we should prioritize normalizing mental health and mental illness in a way that it is as equally important as our physical
Do you have more questions?
Schedule a call or send us an email!
Legal Notice
(OMB Control Number: 0938-1401)
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 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 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 protection 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: www.cms.gov/nosurprises/consumers
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
(OMB Control Number: 0938-1401)
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 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 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 protection 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: www.cms.gov/nosurprises/consumers
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
Click HERE to read the full policy.
