Insurance and Payment

Is therapy covered by my insurance?

Services may be covered in full or in part by your health insurance or employee benefit plan. Call the number on the back of your insurance card to find out what Mental Health benefits are covered and if Dr. Oren is in-network for your plan. Our staff work to verify insurance benefits prior to your first visit, but are not able to guarantee this service or the ability to inform you of your insurance benefit coverage.

We recommend you call your insurance for an Explanation of Benefits to find out what benefit are available to you. Some questions to ask to help you better understand the benefits available to you:

• Do I have benefits for mental (or behavioral) health visits?
• Are there any limits on this benefit?
• Is Dr. Oren an in-network provider for my plan?
• Does my coverage include telehealth services through provider’s own telehealth platform?
• What is my deductible and has it been met?
• How many mental health sessions per calendar year does my insurance plan cover? (These sessions would be considered outpatient or office sessions)
• What is the coverage amount per therapy session?
• What is my co-pay?
• Is a referral required for me to initiate mental health visits?

Your insurance coverage is a contract between you and the insurance company. Dr. Oren’s professional relationship is with you, not your insurance company. Not all services are a covered benefit in all contracts. Any balance that accumulates because of a discrepancy between your payment and the insurance company’s is your responsibility. All charges are your responsibility whether your insurance company pays or not. Payment is due at the time of service. We accept most major credit cards, cash, and check.

In-Network

Dr. Oren is in network with the following:

• Aetna
• Hometown Health
• Optum
• Prominence Health Plan
• United Medical Resources (UMR)
• United Healthcare (UHC / UBH)

Out-of-Network

If Dr. Oren is not an in-network provider for your plan, you may be able to get reimbursed by your health plan by filing the claim to request repayment for the services. We will provide a Superbill to you, upon request. A Superbill is the most commonly used option for out-of-network providers. Superbill is an itemized statement we provide our out-of-network patients so that they can get reimbursed directly from their insurance company. We work with you to help this process as much as we can. 

If you would like to use out-of-network benefits with your insurance company, we recommend you call your insurance for an Explanation of Benefits to find out if you have this benefit available to you. 

• Do I have out-of-network reimbursement benefits for mental (or behavioral) health visits? Are there any limits on this benefit?
• Does my coverage include telehealth services through provider’s own telehealth platform?
• What is my deductible and has it been met?
• How many mental health sessions per calendar year does my insurance plan cover? (These sessions would be considered outpatient or office sessions)
• How much does my plan cover for an out-of-network (OON) mental health provider?
• What is the deductible for out-of-network benefits?
• How do I obtain reimbursement for therapy with an out-of-network provider?
• What is the coverage amount per therapy session?
• Is approval required from my primary care physician?

Dr. Oren is out-of-network with regular Medicare – this does not automatically exclude Advantage plans. If you have a Medicare Advantage plan for your primary insurance, please inquire with your insurance company about coverage. We may be able to utilize out of network benefits for your Advantage plan, but it is not a guarantee. 

Dr. Oren is out-of-network with Medicaid. We recommend that you use the Medicaid website https://www.medicaid.nv.gov to find in-network provider.

Good Faith Estimate

Our office will also provide you with a Good Faith Estimate (What is a good faith estimate?) to help you understand the estimated costs associated with your course of care.You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Disclaimer:
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your mental health care needs. The estimate is based on the information known to me when I did the estimate. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances arise.

Yelena K. Oren, Ph.D., NV License PY0828
155 Cadillac Place Reno, NV 89509-4355
(775) 525-8100

If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact Dr. Oren at the contact listed above 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. To learn more and get a form to start the process, go to: www.cms.gov/nosurprises or call CMS at 1-800-985-3059.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059. This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed more than $400 than the estimate provided.

Cancellation Policy

Cancellation Policy
When you make an appointment with Dr. Oren, this time is reserved especially for you. Just as you deserve your provider’s full attention during your appointment, we greatly appreciate knowing in advance when a client is unable to keep their appointment. When appointments are cancelled with less than 48-hour notice, it is almost impossible to fill that time slot. If you need to cancel an appointment, please be aware of our requirement of at least 48-hour notice. Your account will be charged a full session fee for the reserved service amount if you miss a scheduled appointment or cancel an appointment with less than 48-hour notice. Insurance will not pay for this fee. These policies are presented in the best quality and tradition of excellent service for our established and future clients.

After two no shows Dr. Oren may decide to terminate further services from the practice.

Lateness Policy
Sessions are scheduled for full 55 minutes. Once your appointment has been scheduled, please arrive on time. If you are late for your session, it will still end at the regular time so that Dr. Oren has time to prepare for the next appointment and be on time for them. If we need to bill your insurance for a shorter session time than was scheduled, you will be billed for the difference. If you leave session early and this time difference results in us billing your insurance for a shorter session than was scheduled, you will be billed for the difference. Insurance will not pay for this fee.