CHARGES FOR MENTAL HEALTH (MH) AND INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) COMMUNITY SERVICES
The mental/behavioral health and IDD services the Heart of Texas Behavioral Health Network offers are funded by the State of Texas, local government, and consumers who can pay.
HOW THE CENTER CHARGES FOR SERVICES
The Center will not turn you away from services because you cannot pay for them. The amount that the center charges for services is based on your ability to pay. How we decide your ability to pay is fair and is the same for everyone. We will show you the way we did it and answer your questions.
WHAT WE NEED FROM YOU
- To provide proof of your household income
- To provide proof of any extraordinary expenses (major medical expenses, childcare expenses, significant property loss or damage)
- The number of people in your household
WHAT YOU WILL PAY
Your income (minus any extraordinary expenses) and the number of family members will be applied to a fee schedule to get your maximum monthly fee. First, Center staff will tell you the amount of your maximum monthly fee and give you the fee schedule we used. Then, Center Staff will provide you with the form to decide your maximum monthly fee. If your maximum monthly fee exceeds zero, you will receive a bill for services. Of course, you may pay more than your maximum monthly fee if you want.
Note: Parents are not responsible for adult children's maximum monthly fee. Children are not responsible for their parents' maximum monthly fee. If more than one family member receives services, the maximum monthly fee is for the family.
IF YOU HAVE MEDICARE OR MEDICAID BENEFITS
Medicaid-covered services will be billed directly to Medicaid. You will not receive a bill for any services paid by Medicaid. If you have Medicare, you are responsible for co-insurance and/or deductibles up to your maximum monthly fee. If Medicaid or Medicare does not cover your services, then you may be charged up to your maximum monthly fee.
Consumers eligible for benefits, who do not wish to apply, may be charged the full standard fee for services. (Texas Administrative Code)
IF YOU HAVE PRIVATE HEALTH INSURANCE
If you have private health insurance and complete an assignment of benefits, the Center will bill your insurance company directly for covered services. You are responsible for charges that the insurance company does not pay for. If you have insurance and do not complete an assignment of benefits, the Center may charge you the full standard rate for services. If the Center is not a provider for your insurance plan, we will assist you in locating a provider who accepts your insurance.
TRUSTS AND CHARGES FOR COMMUNITY SERVICES
Some individuals or their family members set up trusts to provide for their or their loved one's care and treatment. Trusts may be subject to claims for some or all BHN services. Anyone concerned about protecting trusts from liability should consult with their attorney.
FINANCIAL HARDSHIP
If it is difficult to pay all charges owed, the Center may be able to arrange for you to pay a lesser amount each month temporarily. For example, if you have private health insurance and financial hardship prevents you from paying your full co-insurance, co-pays, or deductible, we will make arrangements to pay no more than your maximum monthly fee (or $5.00 a month if your maximum monthly fee is zero).
REDUCTION OR TERMINATION OF SERVICES FOR NON-PAYMENT
When it has been determined through a financial assessment that an individual can pay, whether through the determination of a maximum monthly fee (MMF) or third party, the Center will make every reasonable effort to collect on past due accounts. Each account is appropriately assessed, and if needed, the Center will conduct a follow-up financial assessment to evaluate the ability to pay. If it is determined that non-payment is not related to the person's mental health crisis and, despite reasonable efforts to secure payment, the responsible party refuses to pay. The Center may propose to involuntarily reduce or terminate the services to a person for non-payment by the person (or parent).
You have the right to appeal any decision. You may request that the appeal decision be reviewed by the Office of Consumer Services and Rights Protection-Ombudsman, 1-800-252-8154, representing DHS and DADS.
Note: if we do not accept your private health insurance and refer you to another provider to receive services, you may appeal this decision as a denial of services. Instructions for appeal are in the written notification of denial or termination.
If you have any questions or concerns, please get in touch with our Billing Department, at PO Box 890, Waco, TX, 76703-0890, or call (254) 752-3451 or toll-free, 1-866-752-3451.
Download a PDF version of the HHSC BEHAVIORAL HEALTH Monthly Ability to Pay Fee Schedule (effective March 1, 2020)