Insurance and Payment Options
Accepted Insurance Plans:
NOTE: To verify your insurance, you may call the members benefits number on the back of your insurance card. Please ask them if I am a provider for your specific plan as I can not guarantee as there are many private plans for companies that are managed by the insurances above and they may have specific providers on their panel. As well, you may verify what your copays or deductibles are for your individual plan at that time. (If you have any problems with getting this information please let me know and I can be of assistance).
NOTE: Your insurance or employer ultimately decides what benefits are included in a managed care company contract, which may affect:
Accepted payment options: Cash, Check, Credit card, HSA
- Aetna
- BlueCross and/or BlueShield
- Medica
- Midlands Choice
- Tricare
NOTE: To verify your insurance, you may call the members benefits number on the back of your insurance card. Please ask them if I am a provider for your specific plan as I can not guarantee as there are many private plans for companies that are managed by the insurances above and they may have specific providers on their panel. As well, you may verify what your copays or deductibles are for your individual plan at that time. (If you have any problems with getting this information please let me know and I can be of assistance).
NOTE: Your insurance or employer ultimately decides what benefits are included in a managed care company contract, which may affect:
- whether or not mental health care is covered,
- if there is a limit for the number of clinicians in a given area or by credential,
- how much you pay for a deductible or co-payment,
- limitations on coverage by diagnosis, type of service, or number of sessions in a given year.
Accepted payment options: Cash, Check, Credit card, HSA
Vicki Holoubeck MS CPC LIMHP
1406 Fort Crook Road, Suite 401, Bellevue NE 68005
402-880-9453, Vicki@vickiholoubeckcounseling.com, Vickiholoubeckcounseling.com
STANDARD NOTICE
“Right to Receive a Good Faith Estimate of Expected Charges ”Under the No Surprises Act
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 services, including psyhotherapy
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy and crisis services.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one 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 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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 402-880-9453.
1406 Fort Crook Road, Suite 401, Bellevue NE 68005
402-880-9453, Vicki@vickiholoubeckcounseling.com, Vickiholoubeckcounseling.com
STANDARD NOTICE
“Right to Receive a Good Faith Estimate of Expected Charges ”Under the No Surprises Act
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 services, including psyhotherapy
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy and crisis services.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one 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 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.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 402-880-9453.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital, ambulatory surgical center, or care provider 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 to not 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
If you believe you’ve been wrongly billed, you may contact:
DHHS Licensure Unit
Attn: Mental Health
PO Box 94986 Phone (402) 471-2117
Lincoln NE 68509-4986 Email Address DHHS.Licensure2117@nebraska.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.
OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital, ambulatory surgical center, or care provider 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 to not 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:
- 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 pay an 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.
If you believe you’ve been wrongly billed, you may contact:
DHHS Licensure Unit
Attn: Mental Health
PO Box 94986 Phone (402) 471-2117
Lincoln NE 68509-4986 Email Address DHHS.Licensure2117@nebraska.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.
