Billing and Good Faith Estimate
Texas Insight Center is out of network for insurance plans, and we do not file with insurance. We are happy to provide you with a superbill that includes the information necessary to file with your insurance company for out-of-network reimbursement. Your policy determines the reimbursement you receive, and we suggest you contact your insurance company to determine precisely what they will cover.
Some plans may require a reauthorization for services. You are responsible for obtaining any prior authorizations or pre-certifications your plan requires.
Session Costs
Each 45-minute session is $150. Texas Insight Center accepts cash, checks, and all forms of credit cards for payment. Clients are expected to pay the full fee for services when services are rendered. We then provide clients with a receipt they can submit to their insurer for personal reimbursement. Reimbursement from insurers varies by insurance plan and is often 50-75% of the service fee).
Good Faith Estimate Notice
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
You have the right to receive a Good Faith Estimate for the total expected cost of any healthcare items or services upon request or when scheduling such items or services.
If you schedule a healthcare item or service at least three business days in advance, make sure your healthcare provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a healthcare item or service at least 10 business days in advance, make sure your healthcare provider or facility gives you a Good Faith Estimate in writing within three business days after scheduling. You can also ask any healthcare provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within three business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email [email protected], or call 1-800-985-3059.
Privacy Act Statement
PRIVACY ACT STATEMENT: Texas Insight Center, PLLC is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to: (1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program; (3) evaluate selected IDR entity’s compliance with program rules.
Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.