INSURANCE OPTIONS
Insurance Plans Accepted
Greater Life Grief Counseling, LCSW accepts many insurance plans for individuals in New York. Kelly is licensed to provide telehealth services to individuals in Florida or South Carolina but not be credentialed with your insurance. Please contact your insurance company to verify that Kelly Daugherty, LCSW-R is in-network with your specific plan.
Accepted NY Insurances:
Aetna
Blue Cross Blue Shield- Anthem
BSNENY- Highmark
CDPHP
Cigna
Fidelis
Humana
Medicare
MVP
Tricare
United- Optum
Out of Network
Self Pay**
Induced After Death Communication is not covered by insurance due to the length of the sessions. Please contact Kelly Daugherty for more information on pricing for this intervention.
You are responsible for contacting your insurance provider prior to the initial session to verify that your coverage is active and that Kelly Daugherty is an approved provider for your plan. However, confirmation of benefits is not guaranteed payment for services. In the event that the insurance company rejects/denies the claim or does not pay in full for all services, rendered, you are responsible for payment in full. You are responsible for non-covered services, deductibles, and co-payments. You are responsible for notifying your therapist if your insurance coverage changes.Greater Life Grief Counseling requires at least 24 hours notice for non-emergency cancellations. I will make allowance for one late cancellation (less than 24 hrs)/no-show at no charge. For the second and third late cancellations, I will charge you $25.00. For subsequent cancellations that happen within 24 hours or for no-shows, the full amount of the session will be charged to you and will need to be paid in full at or before your next appointment. After 4 Late Cancellations in a 12-month period, you will be discharged from therapy. After 2 no-calls/no-shows, you will be discharged from therapy.The credit card on file will be billed for no-show charges, copay, deductibles, and any balances. Co-pays will be charged to the credit card on file within 72 hours unless other arrangements have been made between Kelly Daugherty and the client or parent of the client./denies the claim or does not pay in full for all services, rendered, you are responsible for payment in full. You are responsible for non-covered services, deductibles, and co-payments. You are responsible for notifying your therapist if your insurance coverage changes.
GOOD FAITH ESTIMATE
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.
PRIVACY ACT STATEMENT: CMS is authorized to collect the information on this form and any supporting documentation under section 2799B-7 of the Public Health Service Act, as added by section 112 of the No Surprises Act, title I of Division BB of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). We need the information on the form to process your request to initiate a payment dispute, verify the eligibility of your dispute for the PPDR process, and to determine whether any conflict of interest exists with the independent dispute resolution entity selected to decide your dispute. The information may also be used to:
(1) support a decision on your dispute; (2) support the ongoing operation and oversight of the PPDR program;
(3) evaluate selected IDR entity’s compliance with program rules. Providing the requested information is voluntary. But failing to provide it may delay or prevent processing of your dispute, or it could cause your dispute to be decided in favor of the provider or facility.