Initial Phone Consultation: Free (15 minutes)
Insurance accepted: Kaiser Permanente; Regence Blue Cross Blue Shield; Pacific Source; Aetna, Moda Health, Oregon Health Plan (YCCO only); call or email for details on others. Not all therapists accept all insurances listed here at this time.
As the insured member, it is your responsibility to know if you have a deductible, the coverage of your plan, and your co-pay or co-insurance. Our office will check your benefits prior to your first appointment and will inform you concerning co-pays or your share of the cost for co-insurance. You are ultimately responsible for the cost of any counseling sessions that are not covered by your insurance. Most insurance companies do not cover phone consultations. As a current client, you will not, be charged for a crisis call regarding safety issues—we do not want there to be any barrier to you communicating about your safety needs.
Private pay: Without insurance, the rates for private “out-of-pocket” pay are listed below. Clinicians reserve the ability to reduce fees for their existing private pay clients in cases of hardship. These adjustments are done on a case by case basis.
The Fees for Newberg Counseling & Wellness starting December 1, 2020 are as follows:
|Intake Appointment Individual (55-60 minutes)||$185.00|
|Individual Appointment (55-60 minutes)||$175.00|
|Family Session (55-60 minutes)||$175.00|
|Couples Counseling Intake (75 minutes)||$195.00|
|Couples Counseling Session (60 minutes)||$185.00|
|Initial Phone Consultation (15 minutes)||$0.00|
|Phone Consultations (per 15 minutes)||$25.00|
|Court Appearance Fee per hour||$185.00|
|Returned Check Fee||$25.00|
|Cancellation Fee – Less than 24 hours before appointment||Full Fee for appointment|
|No-show Fee||Cash fee for appointment|
*Cancellation and no-show fees do not apply to OHP clients
*We do not bill insurance companies for Couples counseling/Marriage therapy, or any couples sessions for which the focus is improving the partner relationship only—most insurance companies do not cover this service. These clients will need to pay the full rate at the time of service.
In Compliance with the “No Surprises Act” we are required to give you the following information on our website and to post this information in our physical office:
Newberg Counseling & Wellness, LLC
901 N. Brutscher St. STE 204, Newberg, OR 97132
503-994-8424, email@example.com, www.newbergcounselingandwellness.com
This document was originally written by the Centers for Medicaid and Medicare (December 2021) and posted on their website. The No Surprises Law has already seen several revisions, so it is subject to change.
Centers for Medicare & Medicaid Services. (2021). Standard Notice and Consent Documents Under the No Surprises Act (For use by nonparticipating providers and nonparticipating emergency facilities beginning January 1, 2022). https://www.cms.gov/files/document/standard-notice-consent-forms-nonparticipating-providers-emergency-facilities-regarding-consumer.pdf
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE
(OMB Control Number: 0938-1401)
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.
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:
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
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network
- 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
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket
If you believe you’ve been wrongly billed, you may contact:
Susan Doak, LPC, Practice Owner and if you are still concerned, contact the the Oregon Board of Licensed Professional Counselors and Therapists: (503) 378-5499 or firstname.lastname@example.org
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://www.oregon.gov/oblpct/pages/index.aspx for more information about your rights under the state of Oregon.
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