TYPES OF THERAPY

COSTS AND BILLING OPTIONS FOR THERAPY

Insurance Agreement

Currently, all licensed clinicians (Ashley Parlier, Melissa Peddy, and Stacey Bolt) at Body and Mindfully Healthy, LLC are paneled and contracted with the following insurance companies for in-network billing:

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Aetna

Aetna Betterhealth

Anthem

Anthem Healthkeepers

Blue Cross Blue Shield

Magellan

Multiplan

Optum

Optima

United Healthcare

Virginia Premier

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Please note that only Melissa Peddy is paneled and contracted as an in-network provider for the following additional insurance companies:

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Cigna

MedCost

TriCare East

Value Options EAP through Beacon Health Options

If you are seeing a Resident in Counseling, please know the following:

• Residents can only provide outpatient mental health therapy for those with Medicaid-based insurance, Commercial Anthem, and Cigna;

• Residents may not call themselves professional counselors;

• Residents may not directly bill for services rendered and will bill for services provided through their supervisor; and

• Residents may not represent themselves as independent, autonomous practitioners or professional counselors. 

Please be advised the resident does not have authority for independent practice and is under the supervision of Melissa Peddy, LPC. If at any time you have questions, concerns, or complaints, please contact the resident’s supervisor at (276) 293-1235 or via email at melissa@bodyandmindfullyhealthy.com . 

You have a variety of options to choose from when paying for therapy services: 

(1) direct payment through credit card, 

(2) direct payment through a health savings account (HSA), 

(3) through a contracted insurance company, or 

(4) through a contracted employee assistance program (EAP). 

In order to best serve you, Body and Mindfully Healthy, LLC requires that you disclose which payment method you would like to use prior to the start of therapy services. By selecting an option below you are consenting to use this payment method and agree that you have reviewed all options and are making a fully informed decision about which method of payment you'd like to use. If you would like to change your method of payment at any time, simply request a new copy of this form and we will update accordingly. 

IMPORTANT NOTE: Body and Mindfully Healthy, LLC does not do "back billing", meaning once you select an option for payment, such as an Employee Assistance Program (EAP) or private pay, we are not able to retroactively submit old claims to an insurance company. For this reason, please make certain that if you select the private pay option it is because we are not in-network with your insurance, or you are opting out of using your insurance benefit.

You can choose to pay for your therapy services directly, through check or credit card. You can willfully choose this payment option, either due to Body and Mindfully Healthy, LLC not being an in-network provider with your insurance carrier, or because you are opting to not use your insurance benefits. If you would like to attempt to collect reimbursement from an insurance company this is solely your responsibility, and Body and Mindfully Healthy, LLC cannot make any guarantees of reimbursement, even if you are provided a receipt for services. 

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 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 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 276-293-1235.

Note: This is NOT an option for those with Medicaid-based insurance.

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You can choose to pay for your therapy services through your EAP and understand that Body and Mindfully Healthy, LLC cannot guarantee payment from your EAP and that if your EAP does not cover any services rendered it will be your responsibility to cover the entire cost of all therapy services ($132 per 50-minute session).

You can choose to pay for your therapy services through an HSA account. It is important to review the rules and policies of your HSA account to determine that using your HSA is appropriate and you are allowed to use your HSA funds to cover mental health services. Should your HSA account run out of funds, you would be fully responsible to cover all therapy services through check or credit card ($132 per 50-minute session). 

If you choose to use your insurance benefits with your carrier, call your insurance to confirm that Body and Mindfully Healthy, LLC is an in-network provider with your insurance company. If you would like Body and Mindfully Healthy, LLC to submit claims on your behalf, you are also agreeing to follow through with the contract you hold with your insurance carrier, paying any co-pays, or paying for services until your deductible is met. By using your insurance benefits, you are agreeing to Body and Mindfully Healthy, LLC sending claims on your behalf to your insurance company, as well as contacting your insurance company to verify your mental health and/or substance use treatment benefits/coverage. Body and Mindfully Healthy, LLC cannot guarantee coverage or cost-sharing benefits and that it is ultimately your responsibility to confirm coverage and cover any costs insurance doesn't cover. Body and Mindfully Healthy, LLC is bound by the contract held with in-network insurance carriers and that Body and Mindfully Healthy, LLC will not engage in balance billing, upholding the contracted rate with certain insurance carriers. 

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Copayments and Deductibles:

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Body and Mindfully Healthy, LLC is obligated to collect the copayment/deductible from you if you are receiving services covered by your insurance company and elect to utilize these coverage benefits according to the contract with the insurance company, managed care company, Medicaid, etc. Body and Mindfully Healthy, LLC cannot charge those who have insurance less (or more) than Body and Mindfully Healthy, LLC has contractually agreed to with your managed-care or insurance company unless there is an authorization to do so. Waiving copayments or deductibles for those who have insurance can be considered fraud and is a practice that Body and Mindfully Healthy, LLC will not engage.

We require keeping a credit card on file. You can choose to charge your credit card on file for any copays, co-insurance, or deductibles after each visit or an invoice will be sent to you to pay after each appointment.