-
Psychiatric Diagnostic Evaluation - 60 minutes - $185
Psychotherapy Session - 50 minutes - $185
-
In-Network:
Regence BlueCross BlueShield of Oregon
Healthcare Management Administrators (HMA)
Providence Health Plan (PHP)
PacificSource
Aetna
MODA
Out-of-Network:
United Health Care (UHC)
-
I will complete a benefits check for you as a courtesy, typically prior to your 15-minute consultation (time permitting).
You can also contact your insurance company directly and do this. Call the number on the back of your insurance card and provide them with my NPI# 1568620011, to verify if I am “in-network” with your plan. Then ask for a quote of your benefits for:
Outpatient Mental Health Telehealth services
What is your copay or co-insurance?
Does any deductible apply?
-
I can accept almost any kind of credit or debit card, including:
Visa, MasterCard, American Express, JCB, Discover, and Diners Club
FSA and HSA cards for client payments
In order to start services, you will be asked to put a credit card on file to cover the cost of services or fees.
Your card will be charged, typically, within 24 hours of each services.
-
Regular attendance and engagement at scheduled appointments is a key component of successful counseling.
If you cannot attend an appointment, you must cancel 48 hours/2 business days in advance, or you will be required to pay the full cost of the session ($185).
Please note that Saturdays, Sundays and national holidays are not considered business days and notice of cancellation provided on those days will be deemed received on the next business day.
No Shows:
I will call and send reminder links after about 5 minutes if you are late to your appointment. I will also do an outreach call and/or message. If you are not in the virtual office at 15 minutes past your scheduled appointment time, you will be charged the No Show fee.
-
HEAVERLO COUNSELING LLC
No Surprise Act
Effective January 1, 2022 Congress passed the No Surprise Act (NSA) as part of the
Consolidated Appropriations Act of 2021. The NSA is designed to protect patients from surprise bills at
out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only
for in-network cost-sharing amounts. The NSA also enables uninsured patients to receive a Good Faith
Estimate of the cost of care. Surprise billing occurs when clients receive care from out-of-network
providers without their knowledge. Surprise billing results in higher costs for medical services that would
have been cheaper if rendered by providers inside the patients’ health plan network. NSA is intended to
cut down on surprise costs and also to ban out-of-network charges without advance notice (providing
clients plain-language consumer notice).
Consumer Notice: It is a requirement that out-of-network providers provide all potential clients with
notice that they are outside of the client’s health plan network. All potential clients may waive paying
out-of-network prices for non-emergency services so long as they consent. Good Faith Estimate You
have the right to receive a “Good Faith Estimate” explaining how much your medical care (in this case,
specifically mental health counseling services) will cost. Under the law, healthcare providers are
required to provide a Good Faith Estimate to out-of-network/cash pay clients when they seek services.
Providers are required to:
● Provide a Good Faith Estimate to an uninsured (or self-pay) individual: ○ Within 1 business day after
scheduling (this timeline applies when the primary item or service is scheduled at least 3 business days
before the day the client or patient would receive it) or no later than 3 business days after scheduling
(this timeline applies when the primary item or service is scheduled at least 10 business days before the
client or patient would receive it), depending on scheduling; or ○ Within 3 business days after an
uninsured (or self-pay) consumer requests a Good Faith Estimate.
● Include in the Good Faith Estimate an itemized list of each item or service, grouped by each provider
or facility offering care. Each item or service must share specific details and the expected charge;
● Provide a paper or electronic copy of the Good Faith Estimate, even if the provider also provides the
Good Faith Estimate information to the individual over the phone or verbally in-person;
● Provide the Good Faith Estimate using clear and understandable language;
● If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill;
● You may request that I provide this notice to you in paper or electronic format;
● The form will clearly state I am an out-of-network provider and provide an estimate of the cost of my
services (which I will have calculated in good faith). You are never required to give up your protections
from surprise billing. You also are not required to get out-of-network care. You can choose a provider or
facility in your plan’s network.
Lastly, there is a requirement which states that out-of-network providers must notify health plans when
they provide a client service, and they must certify that they have met the required notice and consent
requirements. I will keep these records for a minimum of seven years.
Complaints: If you think you have been wrongly billed or are uncertain whether the No Surprises Act
applies to you or if you have any additional questions you may call Sarah J. Heaverlo, LPC at or send an email
to info@heaverlocounseling.com You may also contact: The Oregon Board of Licensed Professional
Counselors and Therapists: (503) 378-5499 or lpct.board@mhra.oregon.gov; The U.S. Centers for
Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit
https://www.cms.gov/nosurprises for more information about your rights under federal law
