Insurance

Labyrinth Counseling and Consulting Center is a preferred provider for BlueCross/Blueshield PPO and BlueCross/BlueChoice PPO. BC/BS insurance claims will automatically be submitted electronically. In addition, Labyrinth Counseling and Consulting Center will submit billing for any other insurance company upon request. This service is included in the session fee.

If you do not have BlueCross BlueSheild PPO or BlueCross BlueChoice PPO, then you are out-of-network with our Center. The Illinois No Surprises Act requires us to give you a statement identifying our fees and what you will be responsible for. Your out-of-network insurance may or may not pay a portion of our fees. We encourage you to find out if you have out-of-network benefits with your insurance company and what the deductible is for out-of-network providers.

If you pay out-of-pocket or decide not to use your insurance or have out-of-network insurance, your psychotherapist will provide you with a statement explaining the fees. See more information below about your rights and protections against surprise medical bills and the “No Surprises Act.”

Fees

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS “No Surprises Act”

When you receive emergency care or are 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 be required 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, that is, out-of-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.” Your out-of-network cost is more likely greater 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.

Surprise Billing in Illinois

Illinois state law (Illinois Public Act 096-1523) protects you from “balance” or “surprise” bills when you receive care at an in-network facility or ambulatory surgery center from out-of-network providers who provide radiology, anesthesiology, pathology, neonatology, or emergency physician services at that in-network facility.

How the No Surprises Act pertains to Clients at Labyrinth Counseling & Consulting Center

As providers of Behavioral Health Care, your psychotherapist and/or Board Certified Behavioral Analyst at Labyrinth Counseling & Consulting Center are in-network with only two providers: BlueCross BlueShield PPO and BlueCross BlueChoice PPO. If you are in one of these two plans then you will follow your plan and pay the deductible amount each new year, usually starting January 1, as well as the co-pays or co-insurances that your insurance company requires.

Except in an emergency, your health plan may require prior authorization (or other limitations) for certain items and services. This means you may need your plan’s approval that it will cover an item or service before you get them. If prior authorization is required, ask your health plan about what information is necessary to get approval for coverage.

If you do not have BlueCross BlueSheild PPO or BlueCross BlueChoice PPO, then you are out-of-network with our Center. The Illinois No Surprises Act requires us to give you a statement identifying our fees and what you will be responsible for. Your out-of-network insurance may or may not pay a portion of our fees. We encourage you to find out if you have out-of-network benefits with your insurance company and what the deductible is for out-of-network providers.

If you pay out-of-pocket or decide not to use your insurance or have out-of-network insurance, your psychotherapist will provide you with a statement explaining the fees.

Exceptions to Illinois Surprise Billing Protections

You could still be required to pay an out-of-network bill in certain situations. Illinois’ surprise billing protections only apply to insurance plans regulated by the state of Illinois. Therefore, if your insurance plan is not regulated by the state, you may still be billed for these out-of-network charges. Further, these protections only apply to certain out-of-network providers who are based in an in-network facility; if the facility where you receive these services itself is out-of-network, you can also receive an out-of-network bill. Similarly, these protections do not apply if you purposely choose a provider not within your insurance network.

If you believe you’ve been wrongly billed, you may contact:

The Illinois Department of Insurance
320 West Washington Street Springfield, IL 62767
1-877-527-9431

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.

(OMB Control Number: 0938-1401)