No Surprises Act

As of January 1, 2022, Psychologists and other Health Care providers are required by law to give uninsured

and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or

when the patient requests an estimate.

 

This new requirement was finalized in regulations issued October 7, 2021. The regulations implement part

of the “No Surprises Act,” enacted in December 2020 as part of a broad package of COVID- and spending-

related legislation.

 

The No Surprises Act” aims to reduce the likelihood that patients may receive a “surprise” medical bill by

requiring that providers inform patients of an expected charge for a service before the service is provided.

 

Erie Colorado Counseling, PLLC provides all scheduled patients, and requests for estimates, with a Colorado

Informed Consent & Mandatory Disclosure Statement.  This document encompasses but is not limited to

information that includes all fees and a good faith estimate.

 

The good faith estimate includes expected charges for a scheduled or requested service, including items or

services that are reasonably expected to be provided in conjunction with such scheduled or requested item

or service, and any applicable copayments, coinsurance, and deductibles.

 

https://www.apaservices.org/practice/legal/managed/billing-disclosure-requirements

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Finances

Dr. De Luca does all possible to accommodate each individuals's financial situation.  All payment schedules are

addressed and agreed upon in writing prior to initiating services.  Unless you and Dr. De Luca agree otherwise, fees

are expected to be paid at the time services are rendered.  Insurance Co-Pays are due at the beginning of each

session

• Average Cost Per Session:  $265

• Initial Evaluation: $295

• Self-Pay Reduced Fees

• Insurances Accepted: 

  • Aetna, AARP (UBH), Beacon, Cigna, GEHA, Humana, Medicare, Mutual of Omaha, 

  • Optum [EAP; LHI; Optum; UBH], Tricare, United Behavioral Health (UBH), United HealthCare (UHC),  

  • United Medical Resources (UMR); & Other Insurance Carriers & Employee Assistance Programs (EAPs).

• Accepted Payment Methods: ACH Bank Transfer, Most Major Credit Cards; HSA; Debit Card.

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Specialized Professional Services

Payment schedules for the Specialized Professional Services listed below will be agreed upon as they are requested.

These professional services may not be covered by insurance. Any portion not paid by such third parties is the

individual's responsibility. All payment schedules are addressed and agreed upon in writing prior to initiating services. 

Unless you and Dr. De Luca agree otherwise, fees are expected to be paid at the time services are rendered. 

 

Psychological Evaluation & Report  

Psychological Evaluation, Limited Assessment, Interpretation, & Report

Optum Logistics Health Incorporated (LHI) Veterans Affairs Compensation & Pension Examinations (United Health Group)

Family Medical Leave Act (FMLA) Employee Form

Family Medical Leave Act (FMLA) Psychological Report / Summary Report

Disability Psychological Evaluation, Assessment, Interpretation & Report 

Capacity Psychological Evaluation, Assessment, Interpretation & Report 

Emotional Support Animal (ESA) Evaluations & Letter (For established Erie Colorado Counseling clients who qualify)

Pre or Post Surgical Psychological Evaluation & Report 

Behavioral Health Special Work Accommodations Letter / Forms (ADA) (FMLA) (Title VII)

Other

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Insurance

Dr. De Luca is currently on various insurance panels.  Many insurance companies provide coverage for mental health

services (a.k.a. behavioral health services).  If you have private health insurance coverage (typically through an

employer or independently), be sure to check with your insurance company to see if out-patient mental health services

are covered.  In addition, be sure to check with Dr. De Luca to insure that she is a provider with your insurance

company or what other options are available.  If Dr. De Luca is unable to accommodate your particular insurance needs,           

you will be provided with referrals to other licensed therapists who may be of consideration, and who accept your                            insurance.

 

If mental health services coverage is provided, be sure to ask your insurance company the following questions:

-How do I obtain my mental health services benefits?

-Is pre-authorization for mental health services prior to my first visit required?

-Do I need approval for mental health services from my Primary Care Physician (PCP)?

-How much does my plan cover for mental health services within a calendar year?

-How much will the insurance company cover for each session?

-What is the maximum amount that I will be reimbursed for mental health services within a calendar year?

-What out-of-pocket expenses am I responsible for (examples: deductible, co-pays, co-insurance percentages)?

-How many sessions does my plan cover within a calendar year?

-What is my Co-Pay amount for in-network providers?

-What are my costs for out-of-network providers?

-What benefit limitations apply? 

-Is an Employee Assistance Program (EAP) available to assist with costs and licensed therapist referrals?

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Out-Of-Network & Self-Filing Insurance Claims

For those who are out-of-network or self-filing insurance claims, Dr. De Luca, will provide a detailed statement of fees 

and necessary information required by your insurance company to assist you in obtaining reimbursement for mental 

health services.

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Cancellation & Missed Appointment Policy

If you need to cancel an appointment, please notify Dr. De Luca at least 48 hours in advance. If you miss an

appointment or fail to cancel an appointment at least 48 hours in advance, you will be charged a cancellation fee

of $155.00.