Statement of compliance with the No Surprises Act
The No Surprises Act was enacted by Congress on January 1, 2022 to protect patients from the practice of "Balance Billing". The definition of Balance Billing is: When a provider bills you for the difference between the provider’s charge and the amount allowed by your insurance. For example, the provider’s charge is $100 and the amount allowed from your insurance is $70, and the provider bills you for the remaining $30 as a "balance".
This office will never engage in the practice of Balance Billing
Please note the difference between Balance Billing and your copay/coinsurance/deductible, as set by your insurance plan.
Definitions of copay, coinsurance, and deductible
Copay: A fixed amount owed by the patient, determined by the insurance company, as part of the overall allowed amount. For example, the provider charges $100 for a procedure. The insurance allows $70 for the procedure, but pays the provider $60. The remaining $10 is your copay, owed by you to the provider.
Coinsurance: A fixed percentage owed by the patient, determined by the insurance company, as part of the overall allowed amount. For example, the provider charges $100 for a procedure. The insurance allows $70 for the procedure, and pays the provider $56 (80% of the total allowed charge). The remaining $14 (20% of the total allowed charge) is your coinsurance, owed by you to the provider. Please be aware that your coinsurance may differ with each visit, depending on the level of complexity and number of procedures performed during the visit.
Deductible: A fixed amount, determined by the insurance company, that you must pay before your insurance will pay for any services. For example, your insurance plan has a $1,000 deductible limit, the provider charges $100 for a procedure, and the insurance allows $70 for the procedure. The insurance plan pays $0 to the provider, and you are responsible for paying the $70 to the provider. Your total deductible amount for the year is now reduced to $930. Once you reach a deductible total of $0, your insurance plan may then require you to pay a copay or coinsurance for any subsequent visits that year. Deductibles reset back to the limit (in this case, $1000) every 12 months.
The No Surprises Act was enacted by Congress on January 1, 2022 to protect patients from the practice of "Balance Billing". The definition of Balance Billing is: When a provider bills you for the difference between the provider’s charge and the amount allowed by your insurance. For example, the provider’s charge is $100 and the amount allowed from your insurance is $70, and the provider bills you for the remaining $30 as a "balance".
This office will never engage in the practice of Balance Billing
Please note the difference between Balance Billing and your copay/coinsurance/deductible, as set by your insurance plan.
Definitions of copay, coinsurance, and deductible
Copay: A fixed amount owed by the patient, determined by the insurance company, as part of the overall allowed amount. For example, the provider charges $100 for a procedure. The insurance allows $70 for the procedure, but pays the provider $60. The remaining $10 is your copay, owed by you to the provider.
Coinsurance: A fixed percentage owed by the patient, determined by the insurance company, as part of the overall allowed amount. For example, the provider charges $100 for a procedure. The insurance allows $70 for the procedure, and pays the provider $56 (80% of the total allowed charge). The remaining $14 (20% of the total allowed charge) is your coinsurance, owed by you to the provider. Please be aware that your coinsurance may differ with each visit, depending on the level of complexity and number of procedures performed during the visit.
Deductible: A fixed amount, determined by the insurance company, that you must pay before your insurance will pay for any services. For example, your insurance plan has a $1,000 deductible limit, the provider charges $100 for a procedure, and the insurance allows $70 for the procedure. The insurance plan pays $0 to the provider, and you are responsible for paying the $70 to the provider. Your total deductible amount for the year is now reduced to $930. Once you reach a deductible total of $0, your insurance plan may then require you to pay a copay or coinsurance for any subsequent visits that year. Deductibles reset back to the limit (in this case, $1000) every 12 months.
Expected costs of treatment
Reimbursement rates vary by insurance plans, and insurance companies will periodically adjust the total allowed amount. Listed below are estimated charges of services; your actual amount owed may differ, but not by more than $30. Payment in full is due at the time of service, including health plan deductibles or copayments. I accept cash, checks, and credit/debit payments. Online payments may be made through the patient portal.
It is your responsibility to inform me of any changes to your health plan. It is my responsibility to verify your insurance coverage and to inform you in a timely manner if my services are not covered by your plan.
Listed below are the fees which will be billed to your insurance company or, if paying directly, to you:
Substantial work that takes place outside of our scheduled appointment, such as preparing written documents on your behalf or consultation with other providers about your treatment will be prorated at $200/hour. These fees are typically not covered by insurance plans and will be your responsibility. You will be notified when such charges may apply. Telephone calls lasting 20 minutes or longer may be subject to these rates, as well.
Reimbursement rates vary by insurance plans, and insurance companies will periodically adjust the total allowed amount. Listed below are estimated charges of services; your actual amount owed may differ, but not by more than $30. Payment in full is due at the time of service, including health plan deductibles or copayments. I accept cash, checks, and credit/debit payments. Online payments may be made through the patient portal.
It is your responsibility to inform me of any changes to your health plan. It is my responsibility to verify your insurance coverage and to inform you in a timely manner if my services are not covered by your plan.
Listed below are the fees which will be billed to your insurance company or, if paying directly, to you:
- Initial evaluation: $250
- 45-minute session: $200
- 20-minute session: $175
- A $10 charge will be applied to balances not paid within 30 days of the invoice date
- A $20 charge will be applied to balances not paid within 60 days of the invoice date
- Returned checks will be assessed a service fee of $25.
Substantial work that takes place outside of our scheduled appointment, such as preparing written documents on your behalf or consultation with other providers about your treatment will be prorated at $200/hour. These fees are typically not covered by insurance plans and will be your responsibility. You will be notified when such charges may apply. Telephone calls lasting 20 minutes or longer may be subject to these rates, as well.