No Surprises Act Compliance

Effective Date: January 1, 2023
Last Updated: December 14, 2025

Overview

The No Surprises Act is a federal law that protects patients from unexpected medical bills. Envisioning Wellness LLC complies with all requirements of this Act to ensure transparency in healthcare costs and protect our clients from surprise billing.

Your Rights Under the No Surprises Act

1. Good Faith Estimates for Uninsured and Self-Pay Patients

Your Right to a Good Faith Estimate

If you are uninsured or choosing to pay for services yourself (self-pay), you have the right to receive a Good Faith Estimate of the total expected cost for any non-emergency mental health services before receiving treatment.

What's Included in Your Estimate

Your Good Faith Estimate will include:

  • Session fees for therapy or counseling

  • Any assessment or evaluation costs

  • Expected frequency and duration of treatment

  • Total estimated cost for your treatment plan

How to Request an Estimate

  • During Scheduling: We will provide a Good Faith Estimate when you schedule your appointment

  • Upon Request: You can request an estimate at any time by contacting our office

  • In Writing: All estimates will be provided in writing for your records

Your Protection Against Higher Bills

  • If you receive a bill that is $400 or more than your Good Faith Estimate, you have the right to dispute the bill

  • Keep a copy of your Good Faith Estimate for comparison with actual bills

  • For dispute resolution, visit www.cms.gov/nosurprises or call 1-800-985-3059

2. Protections for Out-of-Network Patients

Understanding Your Coverage

If you have health insurance but we are out-of-network for your plan:

  • Services may cost more than seeing an in-network provider

  • Your insurance may cover a smaller portion of the cost

  • You may have higher out-of-pocket expenses

Before Receiving Services

We will:

  • Inform you of our network status with your insurance

  • Provide an estimate of costs

  • Help you understand your out-of-network benefits

  • Assist in finding in-network alternatives if requested

Important Considerations

  • Deductibles: Out-of-network services may not count toward your in-network deductible

  • Out-of-Pocket Maximum: Payments may not apply to your in-network out-of-pocket limit

  • Reimbursement: Your insurance may reimburse at a lower rate for out-of-network services

3. Balance Billing Protections

What is Balance Billing?

Balance billing (sometimes called "surprise billing") occurs when a provider bills you for the difference between:

  • The provider's full charge

  • The amount your insurance agrees to pay

When You're Protected

Federal law protects you from balance billing in certain situations:

Emergency Services

  • Out-of-network emergency care cannot result in balance billing

  • You can only be charged your in-network cost-sharing amount

  • This protection continues even after stabilization unless you provide written consent

Certain Services at In-Network Facilities

  • When receiving care at an in-network hospital or surgical center

  • Protection applies to services from out-of-network emergency medicine, anesthesia, pathology, radiology, and other specified providers

Our Practice

As a telehealth mental health practice:

  • We provide clear information about network status before services begin

  • We do not engage in surprise billing practices

  • We offer transparent pricing for all services

Important Information for Our Clients

For Minnesota Residents

  • Additional state protections may apply

  • Contact the Minnesota Department of Commerce at 651-539-1500 for state-specific protections

For Wisconsin Residents

  • Wisconsin law provides additional consumer protections

  • Contact the Office of the Commissioner of Insurance at 608-266-3585

For North Dakota Residents

  • State insurance regulations may provide additional protections

  • Contact the North Dakota Insurance Department at 701-328-2440

For Washington Residents

  • Washington State has additional balance billing protections

  • Contact the Office of the Insurance Commissioner at 1-800-562-6900

How We Help You

Transparency Commitment

Envisioning Wellness LLC is committed to:

  • Clear Communication: Explaining all costs before services begin

  • Written Estimates: Providing Good Faith Estimates in writing

  • Insurance Verification: Helping verify your benefits before treatment

  • Payment Options: Discussing payment arrangements when needed

Before Your First Appointment

We will:

  1. Verify your insurance coverage (if applicable)

  2. Explain whether we are in-network or out-of-network

  3. Provide a Good Faith Estimate of costs

  4. Answer any questions about fees or billing

  5. Discuss payment options if needed

Ongoing Treatment

For continuing care, we will:

  • Update your Good Faith Estimate if treatment plans change

  • Notify you of any fee changes with adequate notice

  • Provide regular statements showing services and costs

  • Work with you if financial circumstances change

Your Options

If We Are Out-of-Network

You always have choices:

  1. Continue with Our Services: Understanding the out-of-network costs

  2. Request In-Network Referrals: We can help you find in-network providers

  3. Submit for Reimbursement: We provide documentation for insurance claims

  4. Negotiate with Insurance: Your plan may agree to cover services at in-network rates

Payment Arrangements

We offer:

  • Transparent fee schedules

  • Payment plans when appropriate

  • Superbills for insurance reimbursement

  • Discussion of treatment frequency to manage costs

How to Get Help

Questions About Your Estimate or Bill

Contact Our Office:

  • Phone: (952) 314-8364

  • Email: diana@envisioningwellness.com

  • Secure Portal: Available for confidential communications

To Dispute a Bill

If your bill exceeds your Good Faith Estimate by $400 or more:

  1. Contact Us First: We'll review and explain any discrepancies

  2. Federal Dispute Process: Visit www.cms.gov/nosurprises

  3. Call the Help Desk: 1-800-985-3059

To Report Violations

Federal Resources:

State Resources:

  • Minnesota: Department of Commerce (651-539-1500)

  • Wisconsin: Office of the Commissioner of Insurance (608-266-3585)

  • North Dakota: Insurance Department (701-328-2440)

  • Washington: Office of the Insurance Commissioner (1-800-562-6900)

Key Terms Explained

Good Faith Estimate: A written estimate of the expected charges for scheduled services

Balance Billing: Being billed for the difference between the provider's charge and the insurance payment

Out-of-Network: Providers who haven't contracted with your insurance plan

Cost-Sharing: Your portion of costs (copayments, coinsurance, deductibles)

Self-Pay/Uninsured: Paying for services without using insurance benefits

Our Commitment

Envisioning Wellness LLC is committed to:

  • Full compliance with the No Surprises Act

  • Transparent and ethical billing practices

  • Clear communication about all costs

  • Supporting our clients in understanding their financial responsibilities

  • Providing quality mental health services with no financial surprises

Contact Information

Envisioning Wellness LLC
Dorothee Tshiela, MA, LPCC
3470 Washington Drive, Suite 216
Eagan, MN 55122

Phone: (952) 314-8364
Fax: (952) 213-6042

Office Hours: By appointment
Good Faith Estimates: Available upon request and during scheduling

This notice is provided in compliance with federal requirements under the No Surprises Act (H.R.133). For the most current information about your rights, visit www.cms.gov/nosurprises.