The following out of pocket fees will be accepted at each session (cash, check, or credit card on file will be charged). A credit card is required to be on file,  and  there is a Pre-Authorized Health Care Billing Form that will be forwarded to you to complete and sign. Payment is required day of service.

 

• Initial Session - Individual Comprehensive Clinical Assessment = $130

• Individual Session = $100

 

• Initial Session - Couples / Family Comprehensive Clinical Assessment = $150

• Couples or Family Session = $120

 

**$50 for late cancelations (within 24 hours) or no shows**

Please call me if you need to reschedule or cancel your appointment (at least 24 hours prior to the scheduled appointment).

 

 

Insurance Coverage

I will file Beacon Health Options/Carlon and some EAPs. For all other plans, I am considered an out of network provider. My services may be eligible for reimbursement from health insurance companies. You can determine whether you have out of network benefits by contacting your insurance company directly to ask if they reimburse for out of network mental health services. I will provide you with a receipt of your visit, with appropriate diagnostic codes and IDs so that you can be reimbursed directly for any out of network benefits that your particular insurance provides. *Insurance companies require a diagnosis code for reimbursement, and a diagnosis code can become part of your permanent record.

 

It is helpful for you to find out specifics of your mental health coverage with your insurance company by asking the following questions (this information is intended as a guideline and does not guarantee services or insurance benefits):

 

* Does my policy cover out of network mental health services?

* Do I need pre-authorization in order to make an appointment? If so, how to obtain it?

* What is my deductible for these services?

* Is there a maximum number of visits per year?

* What services are covered (e.g., couples therapy, group therapy, teletherapy, phone sessions)?

 

 

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance 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. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

 

To request a Good Faith Estimate from Sonja D. Ellington, MS, CRC, LCMHC, CEAS, Ellington Consulting and Counseling, PLLC, please email your request to sonja@ellingtonconsultingandcounseling.com. A representative will contact you to obtain the personal information you must provide to generate the Good Faith Estimate.

 

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

 

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.

 

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.

 

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 cover emergency services without requiring you to get approval for services in  advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would be in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Visit www.cms.gov/nosurprises or call 1-800-985-3059 for more information about your rights under federal law.