Billing & Insurance
It is important to known and understand our fees and how you may or may not be able to utilize insurance for reimbursement.
Understanding Payments and Insurance
Dianna Wagoner DBA Mentally Focused Counseling is not currently in network with any insurance provider. Therefore, payment in full is expected prior to each therapy session. All services will be considered Out of Network by your insurance provider and any reimbursements for services will be based on your Out of Network benefits. Dianna Wagoner DBA Mentally Focused Counseling can assist you by providing you with the documents you need to paper
file a claim for yourself. If any reimbursement for service is received, they will go directly to the insurance policy holder in the form of a direct reimbursement from your insurance carrier to you or a refund from Dianna Wagoner DBA Mentally Focused Counseling to you. Most insurance companies reimburse services from Out of Network Providers directly to the patient. Filing a claim is not a guarantee of reimbursement. While Dianna Wagoner DBA Mentally Focused Counseling can assist you in understanding your coverage with some carriers, you are ultimately responsible for verifying your insurance benefits.
Insurance Considerations - Verifying your Benefits
Dianna Wagoner DBA Mentally Focused Counseling is an out-of-network provider for all insurance. When talking with your insurance carrier, note that the most commonly used insurance code for services received at Dianna Wagoner DBA Mentally Focused Counseling is "Psychotherapy." Ask your insurance company the following "What are my benefits for Out of Network, Out-Patient Mental Health Care, specifically Psychotherapy?" Are these services subject to deductible? What is my deductible for Out of Network providers? These questions should provide your carrier with the information needed to explain your benefits to you. The information listed above is simply general guidance on discussing and understanding your benefits. Each patient's insurance coverage is unique to their plan and the above information may not apply to your specific coverage.
Summary of Fees
This summary is intended for informational purposes only and not to supercede the Consent for Service form, to be signed by client prior to engagement of services.
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Service Type: Initial Session (including Comprehensive Clinical Assessment)
Length of Session: 40-50 minutes
Fee: $175 for Individuals
Service Type: General Session
Length of Session: 40-50 minutes
Fee: $125 for Individuals
Service Type: Paperwork Completion Fee (requested by client)
Fee: Varies based on request $50 per 15 minutes
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Good Faith Estimate:
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.
You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.
To request a Good Faith Estimate from Dianna Wagoner DBA Mentally Focused Counseling, please email your request to mentallyfocusedcounseling@gmail.com. A representative will contact you to obtain the personal information you must provide to generate the Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
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 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 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:
o Cover emergency services without requiring you to get approval for services in
advance (prior authorization).
o Cover emergency services by out-of-network providers.
o 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.
o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
visit www.cms.gov/nosurprises or call 1-800-985-3059 for more information about your rights under federal law.