Understanding Your Insurance
We accept most major insurance carriers (Aetna, United Healthcare, Anthem / BCBS). Many commercial plans require that you pay a copay and/or coinsurance for each session and they will cover the rest of the cost of therapy. In the case that you have not met your deductible for the year, we will charge you the contracted rate with your insurance company after each session. We encourage you to call your insurance company and get details about your behavioral health coverage (deductible, out-of-pocket, co-insurance, copay, number of sessions per year and the need for any prior authorizations for services) prior to your first appointment.
Deductible – Any medical expense (including therapy) that you pay out of pocket before your insurance starts paying. When you have “met your deductible,” you have paid enough in medical costs that your insurance company starts paying for a portion of the costs (10/90, 20/80, 30/70) which is referred to as coinsurance. For example, if you have a $5,000 deductible and you have only had $1,000 in medical expenses for the year you are responsible for paying the full cost of medical services until your deductible is met, which would be $4,000.
Copay – The set fee you pay before any medical service. Whether or not you have a copay is determined by your plan and your insurance company. Your copay does not go towards your deductible but it will go towards your maximum out of pocket. For example, for a therapy session that costs $100 and your copay is $20, you will pay $20 at the time of the session and we will bill $80 to your insurance.
Coinsurance – The percentage of a medical service that you must pay until your out-of-pocket maximum is met. Your insurance plan will pay for some portion of the costs after you meet the deductible (10/90, 20/80, 30/70). For example, if your coinsurance for a therapy session is 20% and your bill is $100, you would pay $20 for coinsurance and the insurance pays $80. Once you meet your out-of-pocket maximum, insurance will pay for 100% of any covered service.
Out-of-pocket maximum – The maximum amount that insurance will make you pay for services before they start covering 100%. When you pay a copay or coinsurance this goes towards your out of pocket maximum.
If we are out-of-network, you can call your insurance to see if your plan has out-of-network benefits. If so, we will charge our full self-pay rate and will provide you with a super bill to submit for reimbursement. The super bill provides your insurance with proof of service and details about your treatment. A super bill looks like an invoice, and includes information such as a diagnosis, and information about procedures and diagnoses. Insurance may reimburse you directly for any out-of-network benefits.
Ask your insurance company the following questions:
How much of my deductible has been met this year?
What is my out-of-network deductible for outpatient mental health?
What is my out-of-network coinsurance for outpatient mental health?
Do I need a referral from an in-network provider to see someone out-of-network?
How do I submit claim forms for reimbursement?
You can pay for therapy sessions out-of-pocket. Some clients prefer this because it protects their privacy. In order for insurance companies to cover therapy costs, therapists are required to submit detailed information about the services provided. This includes a formal mental health diagnosis and rationale for providing sessions. If you prefer to keep your medical/clinical information private, you may opt to self-pay for therapy.