Billing Practices for Beyond the Body Health Psychology Services

Effective January 3, 2024, Dr. Steiner will charge the following for therapy services:

• 15- minute Consultation Call: Free

• 60 minute Initial Intake Assessment (initial session): $260.00

• 53-60 minute Individual Therapy Session: $235.00

• 38-52 minute Individual Therapy Session: $235.00

  *Most sessions average 50-55 minutes

Cancellation Policy

Starting 1/2/2024, I will be officially granting one “free” missed session per year, per client. The new official No-Show/Late Cancellation Policy is as follows:

In the event that you are unable to keep either a face-to-face appointment or a TeleMental Health appointment, you must notify me at least 24 hours in advance of that appointment time. If such advance notice is not received, you will be financially responsible for the session you missed and you will be billed the full amount of your scheduled session. An email or voicemail with a timestamp of more than 24 hours is acceptable. Please note that insurance companies do not reimburse for missed sessions.

Additionally, as I am aware that occasionally emergencies occur and “life happens”, each client will be permitted to have the late cancellation fee waived one time per 12-month period (i.e. each client may miss up to one session in a 12 -month period of time without being charged the fee for that missed session).

Out-of-Network Provider Notice

Dr. Steiner and any other therapists that may be affiliated with Beyond the Body Health Psychology Services, LLC. in the future are all out-of-network providers. This means we do not participate directly with any insurance companies, nor are we Medicare or Medicaid providers. If you are planning to use insurance for reimbursement, you will be given a Superbill (this is a special kind of receipt) ; this will include all necessary procedure codes for all sessions and payments made. If you choose to use your insurance, you will be responsible for filing this document with your insurance company. There is no guarantee that your insurance will reimburse you.

If you are planning to use insurance, we strongly encourage you to reach out to your insurance carrier and ask about their reimbursement policy and rates.  To find out if you have Out-of-Network benefits and what portion of our services may be covered, please call your insurance company directly. You can contact your insurance carrier by calling the customer service phone number on the back of your insurance card (many times there is a separate phone number for mental health or “behavioral health” services information).  When speaking with your insurance company, you may want to ask them the following questions: 

• What are my “out-of-network” outpatient mental health insurance benefits?

• What is my deductible and how much of it have I met?

• Is it possible to meet with a provider that I choose and submit receipts (or a Superbill) for reimbursement?

• What is the process for pursuing reimbursement?

• Are there any limitations on how many services a year that will be covered? (i.e. Is there a limit on how many sessions per year may be covered?)

• What is the coverage amount per therapy session (CPT codes: 90837 (55 min)  or 90834 (45 min)?

• How long will it take to get my reimbursement?

• Do I need a referral from a primary care physician?

• Do my benefits cover telehealth services (online counseling)?

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE

MEDICAL BILLS

(OMB Control Number: 0938-1401)

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.

The state of Georgia does also have a balance billing law.  This law went into effect went into effect January 1, 2021. Visit https://gov.georgia.gov/ for more information about your rights under Georgia law.

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 protection 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.

Visit https://gov.georgia.gov/ for more information about your rights under Georgia law.

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.

If you believe you’ve been wrongly billed, you may contact: The Georgia Secretary of State at 214 State Capitol, Atlanta, Georgia 30334 or by phone at 404.656.288.  The website is: https://sos.ga.gov/

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.

Visit  https://gov.georgia.gov/ for more information about your rights under Georgia law.