Information on The Federal "No Surprises Act"

 

  • The No Surprises Act takes effect on 1/1/2022. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance a Good Faith Estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This does not include any unknown or unexpected costs that arise during treatment. You could be charged more if complications or special circumstances occur.

  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.

  • You can also ask your healthcare provider(s) for a Good Faith Estimate before you schedule an item or service.

  • If you are billed for more than the Good Faith Estimate of medical costs,

    • You have a right to dispute the bill

    • You can ask the provider for an updated bill to match the Good Faith Estimate

    • You can ask to negotiate the bill

    • You can ask if there is financial assistance available

    • You have a right to initiate a patient-provider dispute resolution process with the US Department of Health and Human Services if the actual billed charges substantially exceed (by at least $400) the expected charges included in the Good Faith Estimate.

      • If you choose this route, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill

      • There is a $25 fee to use the dispute process

      • If the agency reviewing your dispute agrees with you, you will have to pay the price of the Good Faith Estimate

      • If the agency reviewing your dispute disagrees with you and agrees with the provider, you will have to pay the higher amount

  • The initiation of a patient-provider dispute resolution process will not adversely affect the quality of healthcare services furnished to you.

  • 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 866-226-1819.

  • There may be additional items or services the provider may recommend as part of the course of care that must be scheduled or requested separately and are not reflected in the Good Faith Estimate.  Upon request, the Good Faith Estimate can be updated.

  • The information provided in the Good Faith Estimate is only an estimate; actual items, services, or charges may differ from the Good Faith Estimate.

  • The Good Faith Estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from the provider.

Fees and Billing

I do not accept any insurance or insurance payments, nor am I on any insurance panels.  If you are wishing to seek out-of network coverage for payment to me, please reach out to your insurance to clarify your out of network reimbursement benefits, as well as your deductible; you will need to take the lead in coordinating all communications with insurance companies.  I will fill out insurance forms at your request and explicit direction.  I am not a Medicare or Medicaid provider.

 

Payment of the bill is independent of and not contingent on reimbursement from insurance.    Payment is appreciated at the time of the visit or on receipt of bill, though weekly clients will be billed at the end of each month.  In addition to invoices in the form of a CMS 1500 form, which can be submitted to insurance for out of network reimbursement, a monthly statement will be sent if there is a balance at the end of the month.  In the event that you are temporarily unable to pay your bill, please discuss it with me, and I will set up a payment schedule with you. Accounts overdue for more than 60 days may be charged a monthly late fee of 5% of the total balance overdue; in some cases, sessions will need to be temporarily stopped, except in an emergency, until payment is received.  In addition, accounts overdue by more than 90 days may be turned over to a collection agency. 

Fees:  

  

o  Psychiatric Evaluation (scheduled as one 120 minute appt or two 60 minute appts): $1150

  • Additional sessions are sometimes necessary for an evaluation and will be billed at the rates listed below

o  Psychopharmacology/medication management

  • $500 for 30 minutes

  • $550 for 45 minutes

  • $600 for 60 minutes and hourly thereafter

o Meetings with schools/Department of Education/other groups, legal write-ups, or court testimony

  • $600/hour (including transportation, when relevant)


In some cases discussed ahead of time, psychopharmacology appointments can be made for 15 minutes for $300; if the session runs over 15 minutes, the above fees will be charged
 

In cases where fees have been negotiated to a lower than full rate, fees will be increased approximately 2.5-5% annually.

  • You can send in payment in the following ways

  • Fees below full fee will be increased by ~5% as of 1/1/2022.

  • I do not take insurance and payment of the bill is in independent of and not contingent on the timing of and/or extent of insurance reimbursement.

  • I do not accept Medicare; I am formally opted out.

    • The law demands that you not submit my invoices for Medicare reimbursement.

    • We must have a written “contract” for the agreed upon fee for my services.

  • For out-of-network reimbursement by insurance

    • Make certain your insurance company has my Tax ID # (26-2982463, Mark W. Wilson, MD, PC).

    • Once the CMS 1500 insurance reimbursement form is completed, make and keep a copy for your records

      • In most cases, I have only completed my portion of the form;

      • Sign items 12; leave item 13 blank.

      • Diagnostic codes are listed under 21 (A-L); it is then “coded” in 24 E (as, for example, “A” or “AB”). Despite the CMS form explaining how I am to complete the form, insurance will often inaccurately claim I did not list the diagnosis.

      • Complete item 29 if not already completed.

      • You do not need to return the bill/insurance form to me with your payment; make sure to send the form to insurance if you are seeking reimbursement.

      • Make sure your insurance company knows to send reimbursement directly to you and not to me; I must return and insurance payments sent to me back to your insurance.

  • If at any time you feel I made a billing error, please let my assistant Eric Scott Kincaid or me know, and we will make any necessary corrections immediately.

  • Balances overdue for more than 60 days may be charged a monthly late fee of 5% of the total overdue balance, unless a payment plan is arranged with me.