No Surprise Act Law
No Surprises Act 2022 Good Faith Estimate
Frequently Asked Questions about Insurance
We value helping our clients understand how to use their insurance and receive high quality services. We created this document to help you understand that you have choices, whether you decide to use in network or out of network benefits. Fees for 2022 listed at the end to provide you with a good faith estimate.
In network vs out of network benefits
• In network benefits are used when you use a provider who is in network with your insurance plan.
• Some insurance companies have out of network benefits but not all insurance plans.
Pros and cons of in network benefits
• You can see a provider covered by your insurance plan and just be responsible for your copay or co- insurance (your payment responsibility for receiving services).
• There are fewer clinicians paneled by insurance companies for a variety of reasons.
• Sometimes it can still be expensive to see an in network provider because of high copays or co- insurance or if you have a deductible.
Pros and cons of out of network benefits
• You can see a broader range of providers but will pay more out of pocket up front than with an in-network provider.
• Usually you have to pay up front and then wait to see if insurance will reimburse you.
• Insurance plans that have out of network benefits can have different kinds of reimbursement. Sometimes they pay the provider directly and sometimes they pay you back.
What is a deductible?
• Some insurance plans have a deductible which means the consumer pays out of pocket a contracted rate before insurance kicks in to cover expenses. Example, if your plan has a $2500 deductible, you have to spend $2500 on services before the insurance will cover some or most of medical expenses. The contracted rates are what is negotiated between the provider/facility and the insurance company. It is usually lower than the self pay rates for the provider/facility.
• Deductibles tend to reset at the beginning of the plan year. For many plans that is January 1st but sometimes your insurance resets at a different point in the year.
How do I know what my deductible is?
• Sometimes it is written on your insurance card or you can look it up online if you have online access to your insurance plan.
• You can call your insurance company to find out what your deductible is and how close you are to meeting your deductible.
What plans are in network with C4R?
• We are primarily in network with Aetna. We have ceased accepting Horizon BCBS or other insurances except for clients who were already with the practice as of Jan 2022.
How does C4R help you utilize your insurance benefits if you are out of network?
• For any insurances that allow us to submit claims electronically we will submit for you even if we are not in network.
• We submit claims electronically at the end of business day and charge your copay at that time.
Help me understand billing from Simple Practice/Headway
• We verify insurance (for in network plans) before you start treatment. We hope to minimize any surprises, such as inactive insurance, deductibles, high copays/co-insurance. It is always an estimate. Headway will submit claim to your insurance and inform you of the portion that you owe.
What are my potential costs if insurance doesn’t pay?
• There are different rates depending on the type of session you had. If you have any insurance changes during the year please email us. Send a copy of front and back of your insurance card and what the effective date is to: email@example.com or call 609-510-4309
Fees for 2022 (Good Faith Estimate across all diagnoses)
CPT (procedure code) for Masters-level practitioner:
90971 (initial appointment) $200
90837 (53+ minutes) $175
90846 or 90847 (couples/family session) $200
No Show/Late Cancellation (less than 24 hour’s notice) is the same as the session fee.
You and your therapist will determine length of session and how many sessions you should meet. Estimated cost for 13 sessions is between $2275 and $2600 depending on length of session.
You are responsible for payment for each session conducted. If you are using insurance with an in network provider we will attempt to get payment from your insurance first.
TAX ID for business is 84-2304324