I am in network with most plans for the following insurances:
- United Healthcare
- Oxford Health Plans
- Aetna
- UMR
- Oscar
- Empire Blue Cross Blue Shield
- UHC Student Resources
- Cigna
- Fidelis
- MVP
- Out-of-pocket
Session rate:
My current session rate is $120 per 45 minute session.
SLIDING SCALE: ($90) for select low-income clients.
Accepted payment types:
- All major credit cards (Visa, Mastercard, American Express, etc.)
* Please be aware that all clients are responsible for making payments in full (including co-pays) prior to starting their session. Please contact me if you have any questions regarding payment.
NO SUPRISES ACT
Your Rights and Protections Against Surprise Medical Bills
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 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.
[Insert plain language summary of any applicable state balance billing laws or requirements OR
state-developed model language as appropriate]
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 protections 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.
[Insert plain language summary of any applicable state balance billing laws or requirements OR
state-developed model language regarding applicable state law requirements as appropriate]
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 [applicable contact information for
entity responsible for enforcing the federal and/or state balance or surprise billing protection
laws].
Visit [website] for more information about your rights under federal law.
[If applicable, insert: Visit [website] for more information about your rights under [state laws].]
polariscounselingservices.com 