Therapy

Sessions that are scheduled for over 60 minutes will be billed as two individual sessions.  Sessions that are over 60 minutes but not scheduled to be so will be billed using the Unscheduled Additional Session code in 30 minute increments.  Please contact Administration at 800-531-4236 with any questions or concerns.

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BHIS

These rates best reflect the most current costs associated with providing these services to our communities. Discounted rates are available for all dates of service paid in full within 90 days. Thank you for your continued support as we continue to grow our local business. We look forward to serving you in the future.

The No Surprises Act is a U.S. law that was enacted in December 2020 as part of the Consolidated Appropriations Act, 2021. Its main purpose is to protect patients from unexpected medical bills, especially those arising from out-of-network care in emergency situations or situations where they don’t have control over who provides their care.

Here are the key components of the No Surprises Act:

1. Emergency Services: The Act prohibits out-of-network providers from billing patients more than the in-network rate for emergency services, even if the patient didn’t choose the out-of-network provider.
2. Non-Emergency Services at In-Network Facilities: If a patient receives non-emergency care at an in-network hospital or facility, and an out-of-network provider (like a radiologist or anesthesiologist) is involved, they cannot be billed for out-of-network rates. Instead, the provider must bill the patient’s insurance, and the patient will only be responsible for in-network cost-sharing.
3. Advance Notice and Consent: If an out-of-network provider is involved in non-emergency care, they must provide a clear, upfront notice and obtain the patient’s consent to receive out-of-network services. This helps the patient understand the potential costs before agreeing to the service.
4. Dispute Resolution: The Act sets up an independent dispute resolution process where insurers and out-of-network providers can settle payment disagreements without involving the patient.
5. Billing Transparency: The law aims to increase transparency by requiring insurance companies to provide clear and concise information about the network status of healthcare providers.

By eliminating surprise bills, especially in situations where patients have little control, the No Surprises Act helps reduce financial stress related to medical care. It went into effect on January 1, 2022.

Heart and Solutions is required to notify you of our network status with your insurance company prior to starting services. Additionally, our private pay rates are clearly posted in all waiting areas as well as on our company webpage.

Heart and Solutions is NOT responsible for notifying you of your eligibility for your insurance, your start or end dates for your coverage, Heart and Solutions is not responsible for notifying you of termination of coverage, what services your specific plan will or will not cover, your co payments, your deductibles or coinsurance.  If you have questions about your plans coverage, please call the phone number on the back of your insurance card.

Additionally, as required by the No Surprises Act, our private pay rates are clearly posted in all waiting areas as well as on our company webpage.

Please contact our billing department at 1-800-531-4236 ext 701 to speak with our Billing Specialist who can assist you with this information. You can also email us at [email protected].

Heart and Solutions will contract with Employee Assistance Programs (EAPs) on a case-by-case basis. The base rate for services is $200 per session. For more detailed information regarding reimbursement rates and contracting, please have your EAP contact our Billing Department Supervisor, Alison, at [email protected].

Please be advised that while we can verify insurance eligibility,  and network status, at the time of the referral, we are unable to verify your specific plan benefits and out of pocket costs with your insurance carrier. It is your responsibility to verify your own benefits and out of pocket costs with your insurance carrier for the services being rendered. To do so, please call the number on the back of your insurance card prior to your first session. Heart and Solutions will provide a “good faith estimate” upon request. Please email [email protected] to request a good faith estimate.

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Your provider may not be contracted with your insurance company, which means they could be considered “out of network” for your plan. If your provider holds a temporary license, they are ineligible to credential with insurance payers. In this case, claims will be processed under the supervision of a fully licensed and credentialed billing supervisor. For clarification and to obtain the correct information, please reach out to our administrative team at 1-800-531-4236 or by emailing us at [email protected].

A client’s responsibility with insurance typically involves paying for certain healthcare costs that are not covered by their insurance plan. This can include:

1. Copayments: A fixed amount paid for a specific service (e.g., doctor’s visit).
2. Deductibles: The amount the patient must pay out-of-pocket before the insurance starts covering costs.
3. Coinsurance: A percentage of the cost of a service that the patient must pay after the deductible is met.
4. Non-covered services: Some services or treatments may not be covered by the insurance plan, and the patient would be responsible for the full cost.
5. Private Pay Services

Clients should be aware of their insurance coverage details to manage these responsibilities effectively. If you have questions about your plan’s coverage and what you will be responsible for, please contact the phone number on the back of your insurance card.

If you received care from a group practice or organization with multiple providers, the Explanation of Benefits (EOB) may list a different provider within the group, depending on the licensure status of your specific provider. Pre-licensed or temporarily licensed providers are not permitted to credential with or bill insurance directly, which is why their services are billed under the supervision of a fully licensed and credentialed provider. This is a common practice in the medical field. 7 Incident-to Billing Requirements – AAPC Knowledge Center

Certainly. You have the option to make payments towards your account with us at any time, even before receiving a bill from our office. Billing insurance can be a lengthy process and insurance companies have anywhere from 30-90 days to process claims. You will not receive a bill from us until your insurance company has processed as they are the ones who tell us how much you owe. We do send out statements every 2nd Wednesday of the month. If you’re aware of multiple visits and associated copayments, it’s advisable to consider settling these out-of-pocket costs either before or following each session. This proactive approach can help mitigate the likelihood of receiving a consolidated bill later as insurance companies tend to process multiple claims at one time.

For your convenience, there are several methods available for making payments:

• Call us at 1-800-531-4236 to make your payment over the phone with a debit/credit card. Our Administrative/Billing hours of operation are M-F 8am-4:30pm. We accept Visa, Mastercard, American Express, and Discover. If we are unavailable we may be assisting other callers. Please leave a detailed voicemail in our secure voicemail system and we will return your call within 48 hours.

• You can also mail a check or money order to PO Box 233 Grundy Center, IA 50638. We do not encourage clients to mail cash for payment. Please keep in mind potential delays in postal delivery.

• Fill out the bottom portion of your statement with your credit card information and mail that back to us at PO Box 233 Grundy Center, IA 50638. Please keep in mind potential delays in postal delivery.

• Consider setting up auto bill pay through your financial institution for added convenience and peace of mind.

We strive to provide flexible payment solutions to accommodate your needs and preferences. Should you require further assistance or clarification, please do not hesitate to contact our billing department at 1-800-531-4236 ext. 701 to speak directly with our Billing Specialist, who will provide comprehensive support and guidance. Alternatively, you can also reach us via email at [email protected].

Please notify Heart and Solutions right away if your insurance has lapsed or will be lapsing or if you have been made aware of any coverage changes that may impact your services with us. We generally are not made aware of these changes until your claims have already been processed. We want to avoid our clients accruing a large bill if at all possible. For Medicaid/HAWKI clients, you will receive a notice of decision in the mail from the Department of Human Services 30 days prior to any changes in your coverage. If you receive this letter please contact us right away.

Please note that insurance policies administered by your employer are managed and updated directly by them. Your employer reserves the right to make changes to your policy without notifying your provider. However, they are obligated to inform you, the employee, of any updates or modifications, including:

• Addition or removal of providers from their network
• Addition or removal of services or specialties
• Addition or removal of plan exclusions, such as coverage for specific diagnoses

Please direct any inquiries regarding these changes to your employer. Please be sure and contact our Administrative Department regarding changes to your health plan.

Most Medicaid insurances do require a prior approval before BHIS services are able to start. If you have Iowa Total Care Medicaid, Molina Medicaid or Wellpoint (previously Amerigroup) Medicaid, we will get a prior approval from your insurance before BHIS services are able to start.  If you have another insurance, we do not get prior approval to start BHIS services, and it is your responsibility to confirm with your insurance if BHIS will be covered. 

To start BHIS services, you and your child will need to meet with one of our licensed therapists for an assessment. Our BHIS supervisors will then submit this assessment to your insurance to request six months of BHIS services. Medicaid can choose to accept or deny BHIS services, or they might approve only three months of services to start. Prior approvals do typically take one to two business weeks to get approved from your insurance. Once we receive an approval, a BHIS provider will reach out to the family to then begin scheduling weekly BHIS sessions. 

A new assessment will need to be completed every three or six months to request continued BHIS services.

Here is a standard timeline for our billing practices. 

• Client is seen for session
• Providers submit documentation of their sessions once per week. Pending approval (approximately 1-2 weeks) by their supervisor, the session charge is then queued for billing.
• We send out claims once per week to insurance.
• Once the charge goes out to your insurance carrier they have anywhere between 30-90 days for processing, sometimes longer if they’re experiencing delays.
• Once your insurance carrier processes, the processing is electronically posted to your account.
• Once the insurance processing has been posted, you will receive a statement for the remainder that’s due (if any).
• We mail out patient statements the 2nd Wednesday of each month.

This timeline serves as an estimate, as there are several variables at play. Due to these factors, we are unable to guarantee which sessions will appear on each monthly statement.

Your understanding and patience are greatly appreciated as we strive to ensure accurate billing and statement processing. Please be aware that unforeseen circumstances, such as technical issues with our systems or unexpected administrative challenges, may occasionally cause delays. If you have any questions or concerns regarding your services with us, our dedicated billing department is here to assist you promptly.

You can reach us at 1-800-531-4236 ext 701 or email us at [email protected]. As part of our commitment to providing excellent customer service, please rest assured that all voicemails and inquiries will typically receive a response within 48 hours.

Thank you for your cooperation and understanding as we work to resolve any issues efficiently and effectively.

As part of our company policy aimed at ensuring accurate billing and verification processes, we require the Social Security Numbers (SSNs) of both clients and guarantors to be on file. This policy applies uniformly to all clients. While we respect your right to decline providing this information, it is important to note that doing so conflicts with our company’s policies. In such cases, we will regrettably need to refer you to another agency for services.

We understand that divulging sensitive information like SSNs can be intimidating. To address this concern, we offer several secure methods for you to provide this information to our team:

1. Over-the-phone submission: You can securely provide this information to one of our administrative assistants via phone by calling 1-800-531-4236 ext 0. Our administrative personnel will then directly input the details into our secure Electronic Health Record (EHR) software.
2. Secure voicemail: If you are unable to connect with a live person, you can leave the necessary information in our secure voicemail system. Please call us at 1-800-531-4236 ext 0.
3. Online submission: You have the option to complete a ‘Change of Guarantor’ form on our secure website. please use the following link to access the form: Guarantor Form – Heart and Solutions
4. Online inquiry: Alternatively, you can submit a ‘Contact Us’ inquiry through our secure website using the following link: Contact Us – Heart and Solutions

We prioritize the security and confidentiality of your information and have implemented these measures to ensure your peace of mind. Should you have any concerns or require further assistance, please do not hesitate to reach out to us. Thank you for your cooperation.

If you do not have a Social Security Number please contact our administrative team at 1-800-531-4236.