Billing & Insurance
We want all of our clients to have an exceptional experience by ensuring that our intake, billing, client relations processes are confidential, caring, and seamless so you (the client) may focus your entire attention towards your therapy.
To help achieve this goal, we want to ensure that we address your general questions about billing, insurance benefits, and payments for services.
How to Pay Your Bill
If you incur a future balance for past services, we will issue a billing statement and collect that amount at the beginning of each of your next appointment. If you receive a billing statement, you may pay it by any of the below payment options.
Please know that balances that are older than 60 days may be reported as a bad debt and sent to collections
If you would prefer to pay your bill in-person, you may do so by talking with a member of our front desk team at our Timberlake Rd. office.
We accept payments over the telephone via credit card free of charge. Please contact us at (434) 384-1594 to speak with a member of our team!
If you receive a billing statement, you may submit your payment in full along with a copy of the billing statement to 20564 Timberlake Rd., STE B, Lynchburg, VA 24502.
Accepted Insurances & Finance Options
We are pleased to offer a wide range of options to cover the cost of your services. Please know that while we list many of these payment options, there are some instances where only a certain provider can accept a particular insurance or payment option. Please contact our billing department if you have questions about additional insurance or finance options.
Understanding Key Insurance Terms
Insurance billing can be confusing so we want to help you navigate this complex terminology. You and your health insurance company pay for your health care expenses. Deductibles, coinsurance and copays are all examples of what you pay. Understanding how each example works helps you know how much you pay.
A deductible is an amount you pay for health care services before your health insurance begins to pay.
How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.
A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service but will remain the same regardless if your session is 30 minutes or 60 minutes.
How it works: Your plan determines what your copay is for different types of services, and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe coinsurance.
Your insurance card may list copays for some visits but you can usually log in to your insurance account (or register for one) to see your plan’s estimated copays.
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage (%) of the amount we are allowed to be charged for services. You start paying coinsurance after you’ve met your plan’s deductible.
How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan pays 70 percent. The 30 percent you pay is your coinsurance.
Explanation of Benefits
Your insurance company should send you a document explaining what they paid on charges submitted by your clinician. This form is referred to as the Explanation of Benefits, or “EOB” for short. Your Explanation of Benefits will tell you if your charges were applied to your deductible or denied for some reason.
They will also tell you how much was paid, how much was adjusted off due to the contractual agreement between your insurer and your provider, and how much is left for you to pay.
Most EOB’s show a breakdown of the charges under several headings which usually read from left to right. The most common headings are:
We recommend that you compare your insurance EOB’s to the the receipt and/or bill you received from Light Counseling. It is always a good idea to check if the payment was posted correctly and the amount owe or already paid matches the amount indicated on the EOB. Light Counseling makes this comparison easier by including detailed charge and payment information on all your billing statements. Any questions about your bill can be directed to our Client Account Representatives.
Date of Service
the date of the appointment or procedure.
codes used by the provider to tell the insurance company what services were rendered to the client.
the amount of charges submitted by the provider.
the amount the insurance company approved for payment. Insurance companies often have pre-determined dollar amounts that they consider “usual and customary” for each medical service code. This pre-determined amount is often different than what your provider charges for that service. Depending on the contract or agreement between your insurance company and provider, or lack thereof, the difference between the Approved Amount and the billed amount may be adjusted (reduced to $0) or transferred to Patient Responsibility (see below).
the amount the insurance company paid to the provider for the services rendered.
Applied to Deductible
The amount of charges that the insurance company has applied to the deductible. Most insurance plans require the patient to pay for a certain portion of their medical charges each plan year before the insurance coverage begins to pay. This is called the plan deductible and it comprises a portion of the total Patient Responsibility (see below).
Applied to Co-insurance
the amount of charges that the insurance company has applied to the co-insurance element of the plan. Some insurance plans require the patient to pay a percentage of the charges for each medical service. This is called co-insurance and it comprises a portion of the total Patient Responsibility (see below).
the amount you owe. This is made up of the deductible, co-insurance, and any charges not covered by the insurance plan.
Sometimes the insurance company will deny (refuse to pay) a charge for some reason. In this case, the EOB will contain alpha or numeric codes next to each procedure which indicates the reason for the denial. The explanation of these codes will often be found at the bottom of the page or on the reverse of the EOB. Some denial codes require the patient to contact the insurance carrier in order to resolve questions or other issues that are preventing payment from being made.
No Surprise Act
Who Does this impact?
Currently, clients who are receiving services from an out-of-network provider or self-pay clients.
What is the No Surprise Act?
Effective January 1, 2022, the No Surprises Act (passed by Congress as part of the Consolidated Appropriations Act of 2021) is designed to protect clients from surprise bills by holding clients liable only for in-network cost-sharing amounts for the following situations:
- Emergency services at out-of-network facilities OR
- Out-of-network providers at in-network facilities
- Additionally, the act requires that clients receive a Good Faith Estimate (GFE) for the cost of care if they are:
- Uninsured (don’t have insurance) OR Are paying for services 100% out-of-pocket.
What is a Good Faith Estimate (GFE)?
If you are uninsured or choose to pay for services out-of-pocket, you are entitled to receive a “Good Faith Estimate” of what the charges could be for psychotherapy services provided to you.
While it is not possible for our clinicians to know (in advance) how many sessions may be necessary or appropriate for a given person, the GFE provides an estimate of the cost of services to be provided. Your total cost of services will depend upon the number of sessions you attend, your individual circumstances, and the type and amount of services that are provided to you. This estimate is not a contract and does not obligate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified in the GFE. Furthermore, the GFE is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of visits. The number of visits that are appropriate for your case, and the estimated cost for those services, depend on your needs and what you agree to in consultation with your clinician. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time. If you attend therapy for a longer period, your total estimated charges will increase according to the number of visits and length of treatment.
This GFE shows the costs of items and 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 GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are never required to give up your protection from balanced billing.
You also aren’t required to get care out-of-network.
You can choose a provider or facility in your plan’s network.
If you are billed for more than your Good Faith Estimate, you have the right to dispute the bill.
You may contact the health care provider or facility 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 ask 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 have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.