Your Rights and Protections Against Surprise Medical Bills & The Good Faith Estimate
1. The Good Faith Estimate (For Uninsured or Private-Pay Clients)
Under federal law, health care providers need to give clients who don’t have insurance, or who are choosing not to use their insurance benefits, an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
- Your health care provider must provide you with a written Good Faith Estimate prior to your service. You can also ask any provider you choose for a Good Faith Estimate during the intake and scheduling process. Mindful Way Counseling uses the information provided on the intake request form and creates a Good Faith Estimate upon scheduling, and uploads it to the client portal as part of the digital intake paperwork.
- If you receive a bill that is substantially higher than estimated (more than $400 above your Good Faith Estimate), you have a legal right to dispute the bill.
- It is highly recommended that you save or print a copy of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
2. Protections for Out-of-Network Clients
When you see an out-of-network healthcare provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or deductible. “Out-of-network” describes providers and facilities that haven’t signed a contract with your specific health plan.
Out-of-network providers are permitted to bill you their full private pay rate, and therefore 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 often higher than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
Choosing Out-of-Network Care Voluntarily:
If you hold an insurance policy that Mindful Way Counseling does not work with, and you actively choose to proceed with our services, you are voluntarily opting out of your network benefits.
In accordance with federal regulations, an electronic out-of-network billing waiver can be signed to pay our standard full fees. By signing this waiver, you acknowledge that:
- You are intentionally bypassing your standard in-network benefits.
- You owe the full costs billed for the services received at our clinic.
- Your health plan might not count the amount you pay toward your deductible or annual out-of-pocket limit.
You are never required to give up your protections from balance billing. To do so, you can choose an alternate provider or facility that actively participates in your plans network. You always maintain the right to choose an in-network alternate provider or facility.
Choosing to Opt-Out of your insurance benefits:
Mindful Way Counseling will never ask or pressure you to forgo using your health insurance coverage. However, if you voluntarily choose to opt out of using your health insurance benefits that we are in network with, please keep the following guidelines in mind:
- Private Pay Responsibility: By opting out, you agree to pay our standard private-pay rates out of pocket at the time of service, which may be higher than the rate discounted by your insurance.
- No Insurance Submissions: You choose to waive the right to submit these claims to your health insurance company for reimbursement, and Mindful Way Counseling will not submit claims on your behalf for any sessions completed while the opt-out agreement is active.
- Good Faith Estimate Protection: Because you are choosing to pay out of pocket, you are federally protected and classified as a self-pay client under the No Surprises Act. This means you have the same right to receive a written Good Faith Estimate of your annual care costs before your sessions begin.
If you choose to opt out of your insurance, our intake team will provide you with a standard Opt-Out & Private Pay Waiver to review and sign through your client portal prior to your first session after opting-out.
For more details regarding your rights under federal law, visit: CMS Consumer Protections.