Understanding Insurance

Insurance can be complicated, so we are here to help you sort if out.

In-Network

If you have an Aetna, Blue Cross Blue Shield, Humana or Wellness logo on your medical insurance card, then you likely are in-network at our practice. This means that we bill your insurance company directly for all sessions and they determine how much you owe, if any. We work with the insurance company beforehand to get an estimate of your responsibility and will charge you at the time of your session. Even with in-network insurance there are some key things to understand, and you should become familiar with your specific plan benefits.

Deductible: Many plans have an annual deductible. This is an amount of out of pocket payments that must be made to your various medical providers for care (doctor’s office, hospitals, routine visits, therapy, etc.) before your insurance benefits kick in and your plan starts to cover your costs. Usually this means that you will have to pay the full rate that is set by your insurance company for your sessions. We will still submit claims to your insurance company so that your payments go toward the annual deductible.

Deductible Waived: Some plans will waive the deductible for mental health, so you would only pay a copay or coinsurance amount, even if you haven’t met the deductible for the year. You’ll see this in your statement of benefits, or by calling your insurance company and asking about costs for mental health visits.

Copay: Once you’ve met your deductible, or if your plan waives the deductible for mental health visits, you may have a copay. This is a flat rate for your visits that is determined by your insurance provider. We will charge you for the copay amount, and then will bill your insurance company for the rest.

Co-insurance: This is a percentage of the billed amount that you would be responsible for each visit. Since this is a percentage of the bill, it could fluctuate if you receive different services, for example 60-minute sessions or group therapy. However most sessions are 45-minutes and we would tell you the co-insurance amount for your regular weekly visit.

Out-of-pocket Maximum: If you have many medical expenses in the year you may reach your out-of-pocket maximum, if your policy has one. This would mean that your insurance company covers 100% of the costs for your visits from that point on, until the new policy year begins.

Claim Processing: All insurance plans come with a disclaimer that benefits are not guaranteed until the claims are processed. We do our best to give you a clear understanding of your costs but if the insurance company determines you owe a different amount than we charged you, you are responsible for the difference or we will issue a refund if you were over charged.

Out of Network

If you don’t have one of our in-network insurance plans, you will have to pay for your sessions out of pocket at one of our rates. Your insurance plan might be able to reimburse you for some of the costs.

Out-of-network Coverage: Check your insurance plans to see if it includes out of network benefits for mental health. If you call your insurance company, you can let them know that you are receiving professional visits for mental health, and provide the CPT code 90834 to see if they will be covered. Our therapists are licenses social workers and we use billable clinical diagnoses, which means that your sessions are considered medically necessary and should be accepted by your insurance company.

Deductible: Most out of network coverage will have its own deductible. This means that only visits to out of network doctors/professionals will apply to this amount and you must reach it before your insurance company starts to help cover costs.

Claims: You are responsible for submitting claims for your visits to your insurance provider. We can provide you with a monthly superbill that will list all of your sessions along with your clinical diagnosis, procedure codes, therapist license information and the practice tax information that the insurance company needs to process your claims. Once you’ve met your deductible, your insurance company will reimburse you for a percentage of your costs. They send the payments directly to you, since you’ve been paying for your sessions out of pocket. The superbill will be sent to your email address as an attachment that you can upload to your insurance provider.

Sliding Scale: Our lowest available sliding scale rate is reserved for folks who do not have insurance coverage. You will have to check with the intake coordinator about what rate is available if you have out of network coverage.