Effective Date: July 1, 2024
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Our services and pricing are provided under two payment structures:
Per-session fees for coaching and therapy services that are based on your child’s treatment.
Membership fees for premium services and resources available in our member app. Members will be informed before purchase of any membership fees associated with accessing premium resources.
For self-pay members, you are responsible for all payments. All billing is done using a credit card that you provide to us when you create your account. You can update your credit card on file at any time in the Brightline app or by speaking with Member Support by calling (888) 224-7332. If your credit card is declined, we will follow up with you directly to update your credit card on file. Please note that if you have an unpaid balance, services may be interrupted or terminated until your balance has been paid.
Coaching Services: $74 per session
Therapy Services: $236 per session
Medication Management Services: $345 for diagnostic evaluation; $235 for ongoing sessions.
Brightline may change its fee structure and payment terms at our sole discretion. If this does occur, Brightline will provide notice of any changes to the fees by posting a notice of change on our website for a period of thirty (30) days.
For members who are employed by companies that Brightline, Inc. (“Brightline”) and Brightline Medical Associates, P.A. (“BMA”) partner with, your services may be covered under the terms of Brightline and BMA's contracted benefits for your employer. For members who have insurance with health plans where BMA is in-network, your services may be covered by your insurance. You have options. Other network providers may offer telehealth and in-office visits. If you see an out-of-network provider, the terms of your plan apply whether you visit in person or virtually. If you have any questions about your eligibility under insurance through your employer, please reach out to Member Support.
Some health insurance companies will reimburse for non-clinical services such as coaching and some will not. In some cases, your use of our services must meet the definition of “medical necessity.” Your health plan outlines which conditions are covered and which are limited or excluded. Most mental health conditions are covered by most plans. If a qualifying diagnosis is appropriate in your case, it may be submitted to your health plan. Any diagnosis made will become part of your permanent insurance records.
BMA has agreed to accept assignment of benefits from certain Payors (e.g., such as certain insurance providers). You will remain personally responsible for payment in full for billed charges to those Payors, unless otherwise required by law. You are responsible to pay all copays, deductibles, co-insurance, and/or other charges, such as services that are not covered by your Payor. By signing this agreement, you agree to pay amounts you owe to BMA in accordance with our payment policies.
Coordination of benefits is the process by which insurance companies determine which Payor has the primary responsibility for a claim in the event that a member is covered by multiple policies. In order to be eligible for Brightline services through any insurance company(ies) or health plan(s), Brightline must be a covered benefit through your child’s primary insurance policy. Failure to provide policy information for your child’s primary insurance policy does not remove your financial responsibility for services received. You are financially responsible for any claims denied due to coordination of benefits.
If you qualify for benefits from any insurance company(ies) or health plan(s), by signing this form, you are agreeing to the following:
Assigning those benefits to BMA to pay for care provided
Signing any additional forms required by any insurance company or health plan (each a “Payor”) to confirm this assignment of benefits.
Authorizing BMA to release all relevant information about your child and their health care necessary to receive payment from the applicable Payor and signing an authorization permitting such release to the extent requested by BMA.
Brightline is not enrolled with and does not accept Medicaid or Medicare in any state. If you have coverage through Medicaid or Medicare, it is your responsibility to inform Brightline of this coverage. You may elect to receive Brightline services at the self-pay rates outlined above, but neither Medicaid or Medicare will be billed for your services. You will be responsible for the full amount. Failure to notify Brightline of this coverage does not remove your financial responsibility for services received.
By signing this agreement you acknowledge and accept that Brightline is not a participating provider of Medi-Cal and you are aware that Brightline’s clinical services are only available at the self-pay amounts outlined above.
Caregivers (i.e. legal guardians) are responsible for payment of services for their child. If a minor is unaccompanied by a caregiver for their appointment and did not consent to the treatment, the child's parent/guardian is responsible for providing payment for services.
Mature minors that consent for treatment without the consent of their parent/guardian are responsible for any copayments or self pay coverage that may apply.
Payment is due after each session, and Brightline will charge your card or bank account for the member’s responsibility. Receipts will be provided after each charge, and a single charge may include fees for multiple sessions (due to Brightline billing to health plans). Your or, as applicable, your child’s insurance may cover some or all of our services. If you have to pay a
deductible, copayment or coinsurance for your or your child’s health care, the usual cost-sharing rules will apply.
Your endorsement and agreement of this Financial Agreement constitutes your understanding that Brightline uses a credit card processing company to process payments. Your submission of your credit card information to Brightline, in conjunction with your agreement of this Financial Agreement, authorizes Brightline to charge the credit card on file for agreed-upon purchases. You understand that your credit card information will be saved on file for future transactions on your account. It is your responsibility to update your credit card information with Brightline as needed.
By signing this agreement, you are attesting that you have authority to use the credit card on file for Brightline services. You consent to allow Brightline to validate authorization of the card on file through identifying information which can consist of the first and last name of the card holder, date of birth of the card holder, billing address of the card holder, driver’s license, or other information.
Refund Eligibility. Refunds that Brightline is able to confirm are owed will be issued for services that were overpaid, duplicate payments, inaccurate billing, services that were not rendered, or services billable to insurance. Refunds are subject to verification and approval by Brightline’s billing department.
Requesting a Refund. To request a refund, you must contact our billing department within 30 days from the date of the original payment or the discovery of the overpayment or non-rendered service. Refund requests can be made by contacting our billing department directly at [email protected]. Please provide accurate and complete information, including your name, contact details, payment details, a brief explanation for the refund request, and any relevant supporting documentation.
Refund Processing. Upon receipt of your refund request, we will review the request and initiate the refund process if it meets the eligibility criteria. Refunds will be processed within approximately 5-10 business days from the date of approval. Refunds will be issued using the same payment method used for the original payment, unless otherwise specified and approved by our billing department. Whether or not to grant a refund request is solely within the discretion of our billing department.
Refund Denial. We reserve the right to deny refund requests. Refund requests submitted after the 30-day timeframe will not be considered, unless there are extenuating circumstances deemed acceptable by our billing department.
No Refunds for Services Rendered. Refunds will not be issued for services that have been rendered in accordance with the agreed-upon treatment plan or for any charges that are non-refundable for any reason including, but not limited to applicable law, regulation, guidance, or agreement. Any disputes regarding services rendered should be addressed separately in accordance with our member dispute resolution process.
Modifications to the Refund Policy. We reserve the right to modify or amend this refund policy at any time without prior notice. Any changes to the refund policy will be effective immediately upon posting the revised Agreement on our website or other appropriate channels.
You have the right to revoke your authorization at any time for BMA or Brightline to release information about your child and their health to any Payor. We ask that you submit the revocation request via email to [email protected]. It will be effective upon our receipt of your email.
Insurance Disclaimer: A quote of benefits, out of pocket estimates, and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service.
Insurance Liability for Payment: Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Every effort will be made by this office to have all services and procedures pre-authorized by your health insurance company, when applicable. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under the plan, your insurer will deny payment for that service. We suggest to all patients that they contact their insurance to confirm that these services are covered. Under this arrangement, you are responsible for paying your co-pay, any non-covered portions, and any deductible amount you have not yet met. In addition, if your insurance company does not pay for our services, you agree to pay for the services provided by Brightline.
Beneficiary Agreement: I understand that my health insurance company may deny payment for the services identified above, for the reasons stated. If my health insurance company denies payment, by signing this agreement, I agree to be personally and fully responsible for payment. I also understand that if my health insurance company does make payment for services, I will be responsible for any co-payment, deductible, or coinsurance that applies.