Insurance & FEes

Insurance

In-Network

River City Counseling LLC is in-network with First Choice Health, Kaiser Permanente, Pacific Source, and Moda health plans.

As a preferred provider, a copay or coinsurance amount is collected at each session. The amount is dependent on your plan, but is usually a set fee or percentage. Your insurance company will be billed directly, covering the remaining balance.

Medical necessity is a prerequisite for using your insurance, which involves the diagnosis and treatment of a mental health condition. Insurance typically does not cover counseling sessions focused on relationship improvement or personal growth, as these services are often deemed outside the scope of medical necessity.

Out of Network

I am able to bill all other health plans as an out-of-network provider. Please check your insurance benefits as you will be responsible for all fees not paid by your health plan.

Checking your Insurance Benefits

You are responsible for all fees not paid by your health insurance. I recommend that you contact your insurance company and ask the following: 

• Is Sara Carmona, LCSW covered as a preferred provider or are her services out-of-network?

• What is my co-pay or co-insurance for each session?

• What is my annual deductible and have I met it? Do I have to meet the deductible before my plan pays for counseling?

• If Sara Carmona, LCSW is out-of-network, what percentage of her services does my plan cover? What percentage is my responsibility?

PRIVATE PAY

To use insurance for counseling, it is necessary to meet the criteria for a mental health diagnosis. This diagnosis is then reported to your health insurance company and becomes a part of your medical record. Self-pay is an option if you do not have health insurance or if you do not want to use your insurance for counseling. This allows for greater privacy and flexibility, as your counseling sessions and personal information are not shared with your insurance company. In accordance with the law, please refer to the NO SURPRISES LAW - DISCLOSURE NOTICE below for information regarding private pay billing for counseling services. This notice is designed to provide you with essential details and ensure transparency in understanding the implications and potential costs associated with utilizing out-of-network services.

FEes

The initial evaluation is $210 and ongoing therapy sessions are $180 per session. Your insurance will be billed directly for you. River City Counseling LLC accepts cash, check, credit card and HSA/ FSA debit cards.

NO SURPRISES LAW - DISCLOSURE NOTICE

This notice is a requirement of the “No Surprises Law” and the content below may not apply to the services provided to you at River City Counseling LLC, however we are providing this notification as required by the law.

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS 

What is “Surprise Billing” sometimes called “Balance 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 healthcare 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

1) Cover emergency services without requiring you to get approval for services in advance (prior authorization), 2) Cover emergency services by out-of-network providers, 3) 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, 4) 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 Oregon Board of Licensed Social Workers, 3218 Pringle Rd SE Ste. 240 Salem, OR 97302-6310 Office: 503-378-5735. Email: oregon.blsw@blsw.oregon.gov

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.