Fees

Know Your Rights Regarding “Surprise Billing” or “Balance Billing”

• Licensed Mental Health Counselors have long been and continue to be ethically and legally obliged to inform clients of their fees before service is provided. Janiece Anjali PLLC’s fees are listed above and in the Client Handbook provided during intake. They will be discussed and documented when scheduling an initial session.

As of Jan. 1, 2021, Federal law protects you from "surprise billing" or "balance billing" if you receive emergency care or are treated by out-of-network providers at your in-network hospital or outpatient surgical facility.

Janiece Anjali PLLC does not provide emergency care or treatment at hospitals or ambulatory surgical centers. However, health providers are responsible for posting and sharing this important information about patient rights and protections against surprise medical bills.

What is "surprise billing" or "balance billing" and when does it happen?

Under your health plan, you’re responsible for certain cost-sharing amounts. This includes copayments, coinsurance, and deductibles.

You may have additional costs or be responsible for the entire bill if you see a provider or go to a facility that is not in your plan’s provider network. Some providers and facilities have not signed a contract with your insurer. They are called out-of-network providers or facilities. They can bill you the difference between what your insurer pays and the amount the provider or facility bills. This is called "surprise billing" or "balance billing." Insurers are required to tell you, via their websites or on request, which providers, hospitals and facilities are in their networks. And hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.

You CANNOT be balance billed for Emergency Services The most you can be billed for emergency services is your plan’s in-network cost-sharing amount even if you receive services at an out-of-network hospital or from an out-of -network provider that works at the hospital. The provider and facility cannot balance bill you for emergency services or certain services at an In-Network Hospital or Outpatient Surgical Facility. When you receive surgery, anesthesia, pathology, radiology, laboratory, or hospitalist services from an out-of-network provider while you are at an in-network hospital or outpatient surgical facility, the most you can be billed is your in-network cost-sharing amount. These providers cannot balance bill you. In situations when balance billing is not allowed, the following protections also apply:

• Your insurer will pay out-of-network providers and facilities directly. You are only responsible for paying your in-network cost-sharing.

• Your insurer must:  Base your cost-sharing responsibility on what it would pay an in-network provider or facility in your area and show that amount in your explanation of benefits. Count any amount you pay for emergency services or certain out-of-network services (described above) toward your deductible and out-of-pocket limit.

• Your provider, hospital, or facility must refund any amount you overpay within 30 business days.

• A provider, hospital, or outpatient surgical facility cannot ask you to limit or give up these rights.

You are never required to give up your protection from balance billing. You are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.

If you receive services from an out-of-network provider, hospital, or facility in any OTHER situation, you may still be balance billed, or you may be responsible for the entire bill. This law does not apply to all health plans. If you get your health insurance from your employer, the law might not protect you. Be sure to check your plan documents or contact your insurer for more information.

If you believe you’ve been wrongly billed, file a complaint with the Washington state Office of the Insurance Commissioner at www.insurance.wa.gov or call 1-800-562-6900.

In Oregon, you can call 888-877-4894 (toll-free) or email: DFR.InsuranceHelp@dcbs.oregon.gov