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Psychologist Session

No Surprises Act



(OMB Control Number: 0938-1401)

When you get emergency care or get treated by an out-of-network provider at an in-network hospitalor ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other 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 health care 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 isinvolved 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 protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

If you get other services at these in-network facilities, out-of-network providers can’t balance billyou unless you give written consent and give up your protections.

You’re never required to give up your protection from balance 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 think you’ve been wrongly billed, contact:

  • Your health plan customer service first. Ask them why you got the bill and if it’s correct. If it was an emergency, ask your health plan if they processed your claim as an emergency. For some health plans, there are additional billing protections for emergency services.

  • For State of Texas consumer services visit or call the Texas Department of Insurance Consumer Help Line at 800-252-3439.

  • The federal phone number for information and complaints is 1-800-985-3059.

  • Visit for more information about your rights under federal law.

Fees and Billing for Anew Therapy, PLLC and Angela Jensen-Ramirez

Therapy services with Anew Therapy, PLLC and all it’s clinicians, including Angela Jensen-Ramirez (Founder, Director), begin when you receive an Informed Consent for Psychotherapy Contract and sign said contract.

Engaging in therapy requires your consent to terms of privacy, confidentiality, and billing.  As laid out in the Informed Consent for Psychotherapy Contract, sessions will be billed per the terms of fee and payment you agree.  Additional time is prorated depending on individuals present and terms of the contract.

Therapy with Anew Therapy, PLLC and any of it’s clinicians including Angela Jensen-Ramirez, can be ended by the client at any time. You, as client/patient have the right to obtain services elsewhere, including with a clinician that is in-network with your insurance.

Anew Therapy, PLLC will do its best to predict how long therapy services for your presenting issue might take in order to provide you a Good Faith Estimate.  

Please keep in mind, your treatment depends largely on your participation in therapy as well as certain circumstances that are beyond your clinicians control- such as new presenting symptoms, changes in goals, unexpected outcomes of interventions (positive and negative), and psychoanalytic processing time which is often not linear.

The total duration of psychotherapy can be difficult to predict given the many unknown aspects of treatment timelines.  You can have a Good Faith Estimate assurance that you will receive billing for sessions as outlined in the Informed Consent for Psychotherapy Contract, that only one clinician will ever work with you (the clinician you are signing contract with in agreement to services), and that you will not receive billing for things that are not explicitly outlined in the Informed Consent for Psychotherapy Contract.

Clients who have signed an Informed Consent for Psychotherapy Contract  and have been surprised by billing are encouraged to first speak with their clinician regarding billing issues.  Angela will do everything in her power to have transparency, clarity, and accountability in her billing practices.

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