No Surprise Billing at Ebenezer

Ebenezer Counseling No Surprise Billing

What is “No Surprise Billing”?

Beginning in January 2022, the Public Health Services Act, a new federal law, requires Health Care Providers to provide information about rights and protections to help prevent surprise and unexpected billing.  Many have experienced the shock of medical bills following a trip to the ER, surgery, or other medical procedure.  Since therapists/counselors are considered Health Care Providers, we are included in this effort to prevent surprise billing. 

Keep in mind that overall therapy/counseling costs cannot be estimated like a surgical or other medical procedure. The number of sessions of your work in counseling depends on many factors to be evaluated collaboratively between you and your therapist.  The best we can do is to inform you of session fees and help educate about possible insurance benefits.

Cash Billing

Cash billing is used when you are paying for your counseling services with cash, check, or credit card and are not attempting to file insurance claims.  Counselors who are working towards getting licensed and interns are not authorized to file insurance claims.  Sometimes licensed therapists do not file claims.  You as a client might not want to file insurance claims because you do not want a mental illness diagnosis on your medical record. 

When paying cash for services, the billing at Ebenezer is simple.  You just pay the counselor’s fee for each session conducted.  There are no surprises or hidden fees.  In some cases where a client expresses financial hardship, a therapist is free to reduce his or her fee to accommodate the hardship. This results in a Net Session Fee. Any reduction of this kind is discussed and agreed to between therapist and client.  There are no surprises here. With insurance involved, this gets more complicated. Keep in mind that your therapist has only one fee for any given service. The Net Session Fee is the maximum your therapist will charge you for a session due to your hardship reduction. See the “Sample Good Faith Estimate” for more clarification.

Out-of-Network Billing (Balance Billing)

At Ebenezer, many licensed therapists file out-of-network claims.  No Ebenezer therapists are in-network.  This means that our therapists have not signed contracts with any insurance company.  We have not agreed to their in-network fees nor do we have to submit to the insurance company’s oversight of therapeutic goals, methods, and session limits. 

Deductible:  If your insurance policy has out-of-network benefits (not all policies do), it means that your policy will most likely have a deductible and co-insurance.  Deductible is the amount that you must pay out of pocket for out-of-network medical or mental health expenses before the insurance company will pay for a portion of your session fees.  Deductibles vary greatly and though we will try to learn the amount, it is your responsibility to communicate with your insurance company to verify if your policy has out-of-network benefits and the amount of deductible your policy has. 

Co-Insurance:  In-network policies have a co-pay.  This is a set amount you pay for a visit or session.  In contrast, out-of-network polices have co-insurance.  Co-Insurance is a percentage of the fee that you will pay after your deductible is met. For out-of-network billing, your Co-Insurance is that amount of the fee your insurance does not pay. If you have a fee reduction based on hardship, your therapist will write-off that reduction amount when your insurance does not pay towards a session’s fee. However, when your insurance company does pay toward your session, there is no write-off because your co-insurance amount is equal to or less than the Net Session Fee. Remember, your Net Session Fee is the maximum you will have to pay for any session with your therapist. See the “Sample Good Faith Estimate” for more clarification.

Allowed Fee:  This is one area of insurance where clients are frequently surprised negatively.  When your insurance policy says it will pay 50% of the allowed fee (or usual and customary fee), it does not mean that they will pay 50% of the actual fee.  For instance, if the therapists session fee is $140, but the insurance company only allows for a $100 fee, then they will only pay the 50% of $100.  So they pay $50 and you get to pay the remainder $90.  So even though your Co-Insurance is 50%, you end up paying 64%. 

Neither your therapist nor Ebenezer has any control over what your insurance company  decides is allowable.  You can try to call your insurance company to determine what this is, but for many companies, this number changes frequently.  So, we actually learn how much your insurance company will help pay when they actually start paying. 

Ebenezer will help you file your claims and get them processed according to the rules of your policy.  It is ultimately your responsibility to know what your policies rules are.   

For more information on how insurance works at Ebenezer, click here to see our Insurance Page.  You can also find it on our website at EbenezerCounseling.com. 

Good Faith Estimate

The Staff at Ebenezer will clarify the session fee during your intake call(s).  When you arrive for your first appointment, they will provide you with a written estimate that will have information about Ebenezer and your therapist;  a clear statement of the fee and any hardship fee reductions; and whether your therapist qualifies to file out-of-network insurance claims. This estimate is not a contract.  You may choose to not see the therapist or switch to another therapist at any time.

You and your therapist will decide whether or not to file claims.  The Ebenezer Insurance team will attempt to verify your out-of-network benefits.  If you have benefits, they will attempt to file claims and track posting of payments along with your co-insurance payments.  We make no promise of any coverage from your insurance company, and you are responsible for any of the fees they do not pay.  If you have paid, and then your insurance company pays on the same sessions, you can use the credit for future sessions, or you can request a refund.  If you are finished with your counseling work and have a credit balance, we will issue a refund to you in a timely fashion.

Your Rights

Though we would love to help with your counseling needs, you are not required to see our therapists.  You have freedom to seek in-network therapists through your insurance company if you want.  Your out-of-pocket expenses will likely be lower than out-of-network therapists except interns and therapists who lower their fee to accommodate hardship.

Though Ebenezer does not provide billed emergency services, you should be aware that agencies, hospitals, or providers who do provide emergency services are no longer allowed to collect fees beyond in-network rates from you. 

If you think you have been wrongly billed at Ebenezer, contact James Berry or Alice Sword at 865 670-0988.  We will be happy to listen and resolve the issue.  You can also visit www.CMs.gov/nosurprises/consumers for information about your rights under Federal Law.  If you believe you have no gotten resolution with Ebenezer administration, you can call 800-985-3059 for information and to make a complaint. We certainly hope to avoid that and will work with you to get the issue resolved.