Understanding Insurance

In Network/Preferred Provider

Ebb & Flow is in-network or a “preferred provider” with Regence Blue Cross-Blue Shield, PacificSource, and PacificSource Community Solutions. If you are insured by one of these companies, you will pay a co-pay for each session. The co-pay amount is set according to the specific plan that your employer, or you, chose. You will need to confirm that your specific plan covers our services, even if it is one of those listed below, as there have been exceptions.

Out of Network Provider

All other insurance plans may be billed for our services as well and we can provide you with documents to submit as a “out of network provider”. Depending on your coverage, your insurance may reimburse Ebb & Flow for a portion of each session. You are responsible for payment of the remaining charges. The amount that insurance will reimburse an out-of-network provider is determined, again, by your specific insurance plan. 

At the beginning of each calendar year, most plans pass on initial health care costs to the patient in the form of a “deductible.” Until your deductible is met, you are responsible for payment in full.

Questions you may want to ask your insurance company:

• Does my current insurance plan have mental health coverage?

• Is Ashley Sapin, PMHNP, FNP and Ebb & Flow Mental Health covered under my plan as a preferred provider, or an out-of-network provider?

• What is my annual deductible?  Have I met my deductible for the current year?

• What percentage of the care will be covered under my current plan?  What portion am I responsible for?

• What is my co-pay for each session?

• What is my maximum benefit (dollar amount or number of visits per year) for mental health care?

Direct Billing

We are happy to bill you directly if we are out of network, you are uninsured, or if you wish to opt out of billing your insurance for any reason. Ultimately, bills become your responsibility if your insurance company does not cover services rendered.

Under the law, health care providers are required to give patients who don’t have insurance or who are not using insurance an 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 includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care 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 health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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 1-800-985-3059.

Payment

Payment of fees is expected at each visit. For those who have made other arrangements, payment by the 15th of the month is required. If such payment is not made, a $25.00 re-billing charge may be assessed for that month. Should the bank return your check, there will be a $25.00 returned check charge. If we cannot collect your balance, your account may be turned over to an attorney or collection agency and you will be responsible for legal or collection costs incurred.

We know this is a lot of information, and we are happy to answer any remaining questions!