Rates & Insurance

Rates

Session rates are $200 for the initial session, $160 for a 53-minute therapy session and $120 for a 45-minute therapy session. Information regarding potential additional fees apart from therapy sessions, such as consultation with other professionals, is provided to new clients.

Insurance

What insurance is accepted?

Dr. Houdek is an in-network provider with Blue Cross and Blue Shield, Preferred Provider Operations (BCBS PPO plans). Dr. Houdek is NOT in-network with Blue Choice PPO plans.

Dr. Houdek is considered an out-of-network provider for all other insurance plans.

Can I work with Dr. Houdek if my insurance plan is different than BCBS PPO?

Dr. Houdek accepts clients with other forms of insurance but is considered an out-of-network provider. Please review this disclosure notice regarding out-of-network billing

What about paying out of pocket?

Self-pay or private pay clients (clients who are paying out of pocket without the use of insurance) are also accepted.

Does my insurance cover all fees? How do I know what I owe?

As a courtesy, Dr. Houdek will gather your insurance information during the initial phone consult and may complete a benefit check to determine any ESTIMATED costs owed prior to the initial session with client permission. Clients are also advised to speak with their insurance company directly to gain an estimate of any fees owed at the time of services, such as a co-pay/co-insurance/deductible. Clients can contact their insurance provider by calling the customer service phone number on the back of their insurance card.

Where applicable, Dr. Houdek will provide a Good Faith Estimate to clients regarding expected charges for those who do not have insurance or are not using insurance.

Under the law, clients have a right to a Good Faith Estimate explaining how much  medical care will cost. Health care providers must provide clients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. The Good Faith Estimate reviews the related costs for the total expected cost of any non-emergency items or services. The Good Faith Estimate should be provided in writing at last 1 business day prior to starting services, clients can ask any provider for a Good Faith Estimate.  Additional information, questions or concerns about Good Faith Estimates can be found at www.cms.gov/nosurprises or call 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.

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 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.

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law or if you believe you’ve been wrongly billed.

What is a copayment (copay):

A fixed fee that you pay at each session. This rate does not change and is due at the time of service. For example, some individuals may have a $25 copay that is paid by the client at each session.

What is coinsurance:

This fee begins once you have met your yearly deductible. Your insurance provider will pay a portion/percentage of the session fee and you are responsible for the remaining portion/percentage. For example, many individuals have a 20% coinsurance in which they pay 20% of the session fee.

What is a deductible:

The amount of money you must pay out-of-pocket before insurance begins to cover your fees. This amount generally starts over at the beginning of each calendar year.

Can I pay with a credit card?

Any fees, such as a copay if applicable, are due at the time of service. Dr. Houdek accepts all major credit cards, including health/flexible spending accounts. Dr. Houdek uses IvyPay, a HIPPA-secure electronic payment application to take credit card payments.

Dr. Houdek does not accept cash or check payments. A credit/debit card must be used to pay for services.

Cancellation Policy

If you are unable to attend a session, please make sure you cancel at least 24 hours beforehand. Otherwise, you will be charged a late cancellation or failed session fee.

Any Other Questions

Please contact me for any additional questions you may have. I look forward to hearing from you!