Charges for Services
We will not deny you services. Our charge for services is based on your ability to pay. The way we determine your ability to pay is fair and the same for everyone.
To determine your ability to pay for services, we need information regarding:
- Your income
- Any extraordinary expenses (for example, major medical expenses)
- Child care expenses, major property loss or damage
- The number of people in your family
Your Responsibility of Payment
Your income (minus any extraordinary expenses) and the number of people in your family will be applied to a fee schedule to get your maximum monthly fee. You will receive the form used to determine your maximum monthly fee. If your maximum monthly fee is more than zero, you will receive a bill for services. You have a choice to pay more than your maximum monthly fee.
Note: Parents are not responsible for their adult children’s maximum monthly fee. Adult children are not responsible for their parent’s maximum monthly fee. If more than one family member receives services, the maximum monthly fee is for the family.
A recipient of Medicaid or Medicare benefits Medicaid-covered services will be billed directly to Medicaid, and you will not be billed for them. If you have Medicare, you are responsible for co-payments, co-insurance, and deductibles up to your maximum monthly fee. If your services are not covered by Medicaid or Medicare, you can be charged up to your maximum monthly fee.
A recipient of private health insurance If you have private health insurance and complete an assignment of benefits, we will bill your insurance directly for covered services. You are responsible for charges your insurance does not cover. If you have insurance and do not complete an assignment of benefits, we can charge you the full standard charge for services. If we are not a provider for your insurance plan, we will assist you in locating a provider who can accept your insurance. You have the right to appeal this decision. Instructions for appeal are in the written notification you will receive if services are denied. To request the appeal decision be reviewed by the Ombudsman for Behavioral Health Unit, call 800-252-8154.
Note: If we do not accept your private health insurance and refer you to another provider to receive services, you can appeal this decision as a denial of services.
Trusts and Charges for Community Services
Some people or their family members set up trusts to provide for their own or their loved ones’ care and treatment. Trusts can be subject to claims for some or all mental health services. Anyone concerned about protecting trusts from liability should consult with an attorney. For example, a statute in the Texas Health and Safety Code, §534.0175, protects a trust from liability for the person’s support, including mental health services if the trust’s assets do not exceed $250,000 and certain criteria for the trust are met.
If it is difficult to pay all charges owed, we can arrange for you to temporarily pay a lesser amount each month. If you have private health insurance and financial hardship prevents you from paying your full co-insurance, co-payments, or deductibles, we will make an arrangement with you to pay no more than your maximum monthly fee (or $5 a month, if your maximum monthly fee is zero) until your balance is paid.
Reduction or Termination of Services for Non-payment
It is our goal to work with you, so you can continue to receive services. If charges remain unpaid and not because of financial hardship, we can propose to reduce or stop your services. You have the right to appeal this decision. Instructions are in the written notification you will receive before services are reduced or terminated. To request the appeal decision be reviewed by the Ombudsman for Behavioral Health Unit, call 800-252-8154.