Billing Information
Insurance
If you plan to utilize insurance we will bill insurance on your behalf. Insurance companies do require the service is medically necessary, and a diagnostic assessment must be on record. Dr. Bach-Gorman will be able to perform the diagnostic assessment during your initial visit. Depending on your current health insurance provider, it is possible for services to be covered in full or in part.
Please contact your insurance provider to verify how your plan compensates you for psychotherapy services.
We recommend asking these questions to your insurance provider to help determine your benefits:
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Does my health insurance plan include mental health benefits?
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Do I have a deductible? If so, what is it and have I met it yet?
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Does my plan limit how many sessions per calendar year I can have? If so, what is the limit?
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Do I need written approval from my primary care physician in order for services to be covered?
Some clients chose to not have a diagnosis on record with insurance, or to have insurance determine the number of sessions, in this case you would pay for services out of pocket. We would not be submitting claims to insurance.
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Your copay or balance due is paid at the time of the appointment.
Co-insurance payments are due after the claim is processed unless you have not reached your deductible.
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Insurance Accepted
Most BCBS plans, Sanford, Sanford True
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Self-pay options are available.
Forms Of Payment
We accept credit cards, HSA cards, cash, and check.
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*rate changes evaluated annually
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Billing questions are managed by Peak Partners at 701.707.1933
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No Suprises Act
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE
MEDICAL BILLS
(OMB Control Number: 0938-1401)
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When you get emergency care or get treated by an out-of-network provider at an in -network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
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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 co-payment, 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.
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.
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.
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Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost if you do not have insurnace or will not be using insurance. Under the law, health care providers need to give patients an estimate of the bill for services provided. For any questions about your right to a Good Faith Estimate
If you believe you’ve been wrongly billed, you may contact my billing consultant: Peak Partners at 701-707-1933
Visit the No Surprises Act for more information regarding your rights under Federal law.
