Insurance & Fees and Your Rights & Protections

Insurance & Fees

At Choices, all staff and independent contractors are post-graduate social work and psychology clinicians who have expertise in working with individuals and families. Fees for clinical services are $150 an hour, and we offer a sliding scale fee schedule, which is determined by financial need; this can include employment status, dis/ability, stay-at-home parenting, and other life challenges. There is no doubt that therapy is expensive, and it is also true that you, and your mental health, are very valuable. At Choices, we work hard to keep our fees reasonable, and to make quality therapy services available for all people. Information about insurance and our policy regarding missed appointments can be found below.

Most services are being provided remotely through Telehealth. Please note that we are currently experiencing extensive wait times for services, and higher than usual email and call volumes. We appreciate your understanding!

We have therapists who participate with: Aetna, Blue Shield of Northeastern NY, CDPHP, Cigna, Empire Blue Cross Blue Shield, Empire Plan NYSHIP, GHI, Medicare, MVP, and Out of Network plans. Please note that we are operating off of a waiting list at this time for all insurance plans. If you have any questions about coverage or wait times please contact our Care Coordinator (carecoordinator@choicesconsulting.com) who can give you an individualized understanding of your options.

We also work with many insurance companies who reimburse for services rendered, often referred to as “out of network benefits.” You must check with your insurance company as to whether they offer out of network benefits. Generally, they will reimburse 50–80% after a yearly deductible. We are glad to fill out all the necessary paperwork to assist you in being reimbursed for the cost of therapy, or we can sometimes bill directly and you will get reimbursed. It is important that you update your insurance information yearly, as your benefits can change.

Please be aware that certain insurance plans are only accepted by a small number of clinicians. If you have a particular provider in mind, please connect with our Care Coordinator (carecoordinator@choicesconsulting.com) to find out if they are compatible with your insurance plan, and if that will affect your wait time. 

All clinical appointments are 55 minutes long, leaving the remainder of the hour for the therapist to complete paperwork and schedule the next session. Fees are expected at the time of services. Fees are inclusive of all services rendered, meaning that if we need to coordinate services with other providers, write psychosocial letters regarding your care, or communicate with your insurance company, this is no extra charge.

For your convenience, we accept cash, credit card, or check. If a check bounces, we will charge the bank fees to your account. We are happy to write you a receipt for taxes, flex spending, or insurance reimbursement.

Missed Appointment Fees

If you cancel an appointment you must give 24 hours notice (48 is preferred) by telephone or email. This allows the therapist to schedule another client during this time. The therapist will try to offer you another alternate time for scheduling during that week, if possible. If the client cannot reschedule during that week, the session is forfeited and the client is responsible for the fee. Missed appointments are charged at the full session rate.

Note: Insurance companies do not provide reimbursement for cancelled sessions.

Although fees are due at the time of service, if your account has not been paid for more than 60 days and arrangements for payment have not been made, Choices has the option of using legal means to secure the payment. If such legal action is necessary, the costs will be included in the claim. We always prefer to work with you regarding overdue fees.

If you would like more information, please email carecoordinator@choicesconsulting.com or call (516) 418-6815.‬

 

 

What is the No Surprises Act?

The federal government passed a law called the No Surprises Act, which went into effect January 1, 2022. Before the No Surprises Act, if you had health insurance and received care from an out-of-network provider or an out-of-network facility, even unknowingly, your health plan may not have covered the entire out-of-network cost. This could have left you with higher costs than if you received care from an in-network provider or facility. In addition to any out-of-network cost-sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also known as a surprise medical bill.

*If you have Medicare, Medicaid, TRICARE, or receive care through the Indian Health Services or Veterans Health Administration, you are not at risk for surprise medical billing because New York state already had these protections in place.*

How Does the No Surprises Act Help Me?

If you have group insurance or individual insurance, you cannot be charged more than in-network cost-sharing for these services. Simply stated, you will pay the in-network portion as contracted through your health insurance. For example, if your health insurance states your office visit copayment is $20 (you can find this information on your insurance card), the provider can only charge you $20. If you are uninsured, use self-pay, or choose to self-pay rather than using your health insurance, providers are required to provide you with a Good Faith Estimate of how much your service(s) will cost. This information will help you to make an informed decision in choosing a provider or facility.

What is the Good Faith Estimate and How Does it Work?

The Good Faith Estimate is geared toward people who are uninsured or self-pay. It’s a notification of expected charges for scheduled or requested mental health and substance use services. The notification is an itemized list of services, the fees for each service, and a diagnosis code(s) that are reasonably expected for mental health and substance abuse services. The expected charge for a service is either:

• the cash pay rate or rate established by a provider for an uninsured (or self-pay) patient, reflecting any discounts for such individuals; or

• the amount the provider would expect to charge if the provider intended to bill a health care plan directly for such service.

Disclaimer

Uninsured or self-pay individuals may challenge a bill from a provider through a new patient-provider dispute resolution process if the billed charges substantially exceed the expected charges in the Good Faith Estimate. “Substantially exceeds” means an amount that is at least $400 more than the expected charges listed on the GFE for a specific provider.

The Good Faith Estimate is based on information known at the time the estimate was created. The GFE does not include unknown or unexpected complications or special circumstances that may arise during treatment. Due to unknown variables, the cost of services may fluctuate and increase your payment. If this happens, federal law allows you to dispute (appeal) the bill.

If any information contained in the original estimate changes, the provider is required to give you a new GFE within 1 business day of your next scheduled visit.

If there is a foreseen need to change providers, there is a requirement to notify you in less than one business day before your next scheduled visit. The replacement provider is required to uphold the original GFE as their expected charges.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to https://www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured or call 1-800-985-3059.