No surprise billing. Our promise.

You will not get an unexpected bill from Positive Reset Eatontown. We verify your insurance benefits before your first visit, give you a written estimate of any copay or deductible before you arrive, and follow the federal No Surprises Act for every patient we see. If a bill ever doesn’t match what we told you up front, call us at (732) 724-1234 and we’ll fix it.

What the No Surprises Act protects

The No Surprises Act is a federal law (administered by CMS, in effect since January 2022) that protects you from unexpected medical bills. For mental health care delivered by a clinic that’s in-network with your insurance, the law guarantees:

You won’t be charged more than your in-network cost-sharing (copay, coinsurance, or deductible) for covered services.
You can’t be billed the difference between what your plan pays and what the clinic charges (called “balance billing”) for in-network care.
If you’re uninsured or self-pay, you have the right to a Good Faith Estimate of expected charges before any non-emergency service.
You have the right to dispute bills that don’t match your Good Faith Estimate by more than $400 through the federal Patient-Provider Dispute Resolution process.

What we do at Positive Reset Eatontown

We go past the legal minimum. Our clinic policy is built on three commitments:

1. We verify your benefits before your first visit

When you call to book, we collect your insurance card details and verify your specific plan’s mental health benefits with your insurer. We confirm in-network status, copay amount, deductible status, prior-authorization requirements, and any session limits. Most plans verify in 5 to 10 minutes; a few require a callback to the insurer and verify within 24 hours. You don’t book your first visit until we’ve confirmed coverage.

2. We give you a written estimate before you arrive

Before your first appointment, you receive a written estimate of what you’ll owe. For insured patients, that’s your copay or deductible amount. For self-pay patients, that’s a federal Good Faith Estimate listing the expected charge per visit and the typical course of treatment. The estimate is in plain dollars, not codes.

3. We honor what we told you

If a bill arrives that doesn’t match what we told you up front, that’s on us. Call us, send us the bill, and we’ll fix it — either by re-billing your insurer or by adjusting the charge. You don’t pay more than what was on the estimate.

Self-pay patients: your Good Faith Estimate

If you’re paying out of pocket (no insurance, or choosing not to use it), federal law entitles you to a Good Faith Estimate of the expected cost of your care. We provide yours before any non-emergency service.

Our self-pay rates are tiered: $150 for individual therapy with a licensed therapist, $200 for psychiatric evaluations, and $125 for medication-management follow-up visits. Most patients can request a sliding-scale rate based on household income; ask at intake. The Good Faith Estimate covers the initial visit plus the typical number of follow-ups for the condition you’re seeking care for — an honest range, not a low-ball quote.

If your final bill exceeds the Good Faith Estimate by more than $400, you have the right to file a dispute through the federal Patient-Provider Dispute Resolution process at cms.gov/nosurprises (opens in new tab). You have 120 days from the date of the bill to file. The dispute process is free and doesn’t affect your ability to keep getting care.

What to do if you get a bill you don’t expect

Call us first at (732) 724-1234. The fastest way to fix a billing problem is to talk to our billing team. Most issues resolve in a single call.
Don’t pay disputed amounts while we sort it out. Federal law protects you while a billing dispute is open.
If we can’t resolve it through our billing team, you can file a complaint with CMS at cms.gov/nosurprises (opens in new tab) or by phone at 1-800-985-3059. New Jersey residents can also file with the state Department of Banking and Insurance.

Common questions

Does this apply to telehealth visits?

Yes. Telehealth visits delivered from our Eatontown office to anywhere in New Jersey are billed at the same rates as in-person visits, with the same in-network protections. The No Surprises Act applies the same way to telehealth as to in-person care.

What if my insurance changes mid-treatment?

Tell us before your next visit. We re-verify benefits whenever your plan changes — new MCO, new employer-sponsored plan, age-related Medicare transition, anything. The “no surprise bill” promise resets each time we re-verify.

NJ FamilyCare members: what do I owe?

Most NJ FamilyCare (Medicaid) members pay $0 for therapy and psychiatry visits at our clinic, regardless of MCO (Horizon NJ Health, Aetna Better Health of NJ, UnitedHealthcare Community Plan, Wellpoint, FidelisCare). There’s no copay, no coinsurance, and no deductible for in-network mental health care under NJ FamilyCare. We confirm at intake before your first visit.

I’m on Medicare. Does the No Surprises Act apply?

The No Surprises Act applies primarily to commercial insurance and self-pay patients. Medicare and Medicare Advantage have separate federal protections that generally already prohibit balance billing for in-network care. The same overall principle applies: you owe only your in-network cost-share, and we tell you what that is before your first visit.

Can I get a copy of the Good Faith Estimate I received earlier?

Yes — call us and we’ll send another copy. We keep your Good Faith Estimate on file for at least three years per federal record-keeping rules.

For the federal text and additional resources, see cms.gov/nosurprises (opens in new tab). If you’d rather speak to someone, call us at (732) 724-1234. We respond within one business day.