Your Rights and Protections Against Surprise Medical Bills
Good Faith Estimate of the Costs of Services
You have a right to know, in advance, the costs of any therapy session you schedule prior to your first session, your therapist must disclose the fee to you. This fee will apply to each subsequent session you schedule, unless you are informed in advance of a change in the fee. The total cost of the entire course of your therapy will depend upon how many sessions you choose to utilize. If you have health insurance, you have a right to know the financial impact of choosing an in network or out-of network provider Please inform your therapist of any health insurance policy you subscribe to.
Your therapist will tell you if they are a “contracted, in-network” provider for your insurance plan. If your therapist is “in-network” then the fee is limited by your insurance plan benefits. Your therapist must disclose their fee to you, and it must not exceed the maximum charge allowed by your insurance plan. If your therapist is “out-of -network”, it means that they are not contracted to abide by the fee limitations of your insurance plan. They can set their own fee. To collect payment, they can request either of two options:
Full Payment for Service:
Your therapist may ask to collect payment in full from you for each session. They may also provide you with a superbill, that you yourself can submit with a claim to your insurance company. If your insurance benefits include payment for services from out-of-network providers, you may receive partial reimbursement of the fees you paid. Your therapist cannot make any assurances regarding whether your insurance company will reimburse you. You will be responsible for the full fee regardless of whether your insurance company reimburses you anything.
Balance Billing:
Your therapist may bill your insurance company on your behalf. You may be asked to pay the difference between the therapist’s fee and the amount your insurance company pays the therapist. This is called “balance billing”. If you want to know how much of the therapist’s fee you will be expected to pay, you or your therapist must contact your insurance company to get an estimate of how much of the fee they expect to pay. Your costs for therapy may be less by using an “in-network” provider. Usually, the fee limitations on in-network providers result in lower costs for you if you choose services from an in-network provider. You can contact your insurance company to help you find an in-network provider. There may be reasons for you to choose an out- of-network provider, but you should know that this choice is yours, and may result in higher overall costs. If you believe you’ve been wrongly billed, you may contact the California Board.
Jonathan Benko, LCSW #81650 is not contracted with any insurance network and requires full payment at time of session. A superbill will be provided upon request for services rendered, that you, the policy holder can submit to your insurance company if you wish to pursue reimbursement. I cannot make any assurances that your insurance company will reimburse you.