Is BGT in Network with Insurance (INN)?

Yes. BGT currently accepts Aetna & BCBS insurances for individual therapy. We are primarily Self Pay for Couples & Family work. We only do In Network billing for Couples & Family Therapy on rare occasions where having one “identified patient” is clinically appropriate. All Prospective Clients will be oriented to our policies in the consultation and intake process. Only our NC based providers are on the commercial insurance group contracts. Providers who are solely PA based are self pay & cannot accept insurance.

Does BGT offer Out of Network (OON) Billing?

We do! For all other insurances outside of Aetna & BCBS, (and for Aetna & BCBS if your provider is only licensed in PA) we have partnered with Thrizer to handle the out-of-network billing & reimbursement process automatically for you. With Thrizer, you will only have to pay your coinsurance for sessions once your OON deductible is met, instead of paying full fee and waiting for reimbursements. This typically allows clients to save on average 50%-70% upfront on sessions once your OON deductible is met. Clients will be oriented to this service in detail during the consultation and intake process. This process is fully automated and clients do not need to submit Superbills to their insurance companies with Thrizer, everything is handled for you. This is a great option if you have decent OON benefits.

Does BGT offer Sliding Scale or Pro Bono services?

We do, but only for existing clients in the Practice who experience unexpected financial hardship. The Sliding Scale/Financial Hardship Program is a policy that is structured, transparent and applied consistently. It is based on financial criteria including a client’s income, debts & dependents as well as access (or not) to forms of intergenerational wealth including large savings, investments, and/or trusts. These offerings are usually time limited to 3-6 months. Ongoing reduced fee or pro bono spots are reserved for existing clients who have multiple marginalizations and no access to family support or insurance benefits.

What are the costs for Services at BGT?

Each therapist has a Usual & Customary Rate (UCR)--or a Standard Fee Rate– for each service they provide. This is the fee that is billed to insurance and it is the fee that is considered their baseline Self Pay rate. Each therapist’s Standard Fee Rate reflects their level of experience and specializations. Prospective clients will be oriented to our fee rates and policies during the consultation and intake process. An all encompassing fee range scale for the purposes of transparency, for Self Pay clients is $140- $225.

Does BGT have a Late Cancel/No Show Fee?

Yes. If a session is cancelled within 24 hours of the scheduled time, the client is still responsible for the session fee, unless the session is rescheduled for a time within that same week. For Insurance Users, a flat rate of $100 will be charged for cancellations under 24 hrs or No Showing to your session.

Does BGT offer Good Faith Estimates (GFE)?

Yes, and we are required to have it posted on our website too.

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We are required by law to provide the following Good Faith Estimate. This estimate is based on a year of weekly treatment (52 weeks), at our standard fee rates. Your total may be less based on a negotiated rate with your clinician.

Common service codes provided by BGT PLLC:

90837: 60 minute psychotherapy , 90834: 45 minute psychotherapy, 90847: family- or partner- assisted psychotherapy with patient present

Common diagnostic codes used by BGT PLLC:

F43.20: Adjustment Disorder, Unspecified; F41.1: Generalized Anxiety Disorder; F90.9: Attention-deficit hyperactivity disorder, unspecified; F43.12: Post Traumatic Stress Disorder, chronic; Z91.49: Other Personal History of Psychological Trauma

Where services will be rendered: Online through agreed upon virtual format

Length of time in treatment:

Your clinician recognizes that every client comes into treatment with different needs and life circumstances. Each client’s journey to healing is unique. The length of time in treatment is determined by many different factors, including: your schedule and life circumstances, Therapist availability, ongoing life challenges, the nature of your specific challenges and how you address them. You and your therapist will continually assess the appropriate frequency and duration of therapy, and will work together to determine when you have met your goals and are ready for discharge.

The current full fee rates for psychotherapy services are:

50 minutes (Individual Psychotherapy):   $150/session GFE: $7800

50 minutes (Couples/Family Psychotherapy): $175/session GFE: $9100

Disclaimer

The Good Faith Estimate shows the cost of services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during the course of treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) services that are more than $400 above the estimated cost of services.

The Good Faith Estimate is not a contract and therefore does not require you to obtain the items or services provided by BGT PLLC. At the foundation of a good therapeutic relationship between client and therapist is the client’s right to self determination and autonomy. Therefore you (as the client) have the right to terminate services at any time.

If you are billed for more than this Good Faith Estimate, you have a right to dispute the bill.

You may contact your clinician to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or as if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, 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 pay the price of the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider, you must pay the higher amount.

To learn more and to get a form to start the process, or to learn more about the Good Faith Estimate or No Surprise Act, go to www.cms.gov/nosurprises or call 1-800-985-3059