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Your Insurance Questions
Confused about using your health insurance for counseling? We provide guidance on what questions to ask, ensuring you get the mental health support you deserve. Start your journey today.
Insurance and Payment Information
I do not accept insurance directly except for HealthChoice Insurance, but I use a fee-for-service model where payment is due at the time of your appointment. Many insurance plans offer out-of-network benefits, which may allow you to be reimbursed for part of the cost. Additionally, you can often pay for services using a Flexible Spending Account (FSA) or Health Savings Account (HSA).
To help with reimbursement, I can provide a detailed receipt called a Superbill. For ongoing therapy clients, Superbills can be issued once per month.
Why Many Choose Private Pay Over Insurance
There are many benefits to the fee-for-service model we use offers and why, in many cases, people choose to use this instead of insurance. It is helpful to understand these benefits to get the help that is best for you.
- Limited Coverage: Some insurance plans have limitations on the number of sessions covered or only partially cover the cost of therapy, making self-pay a more straightforward option for those who can afford it to get the amount of help that will meet your needs with the insurance company dictating that.
- Control over Treatment: When using insurance, treatment might need to follow certain protocols and timelines set by the insurance company. Using self-paying allows the client and therapist have more freedom to determine the course and length of treatment.
- Confidentiality: Self-paying provides a higher level of privacy. If insurance is used, the insurance company has access to the client’s diagnosis, treatment plans, and progress notes. Some people might prefer to keep this information entirely private.
- Choice of Therapist: Not all therapists accept insurance, and some of the best therapists might only take private pay. Therefore, to see a specific therapist, a client might choose to self-pay.
- Avoiding Diagnosis: In order for insurance companies to cover therapy costs, a mental health diagnosis is often required. Some clients might not meet the criteria for a mental health diagnosis, or they might not want to have a diagnosis on their medical record. Diagnosis can have a negative impact on some professions.
- Scheduling Flexibility: Therapists who don’t deal with insurance may offer more flexible scheduling options. Some therapists might offer longer session times or different formats (like walking therapy or online therapy) that may not be covered by insurance. In some situations, longer session times and different formats can increase the effectiveness of your therapy.
- Ease and Simplicity: Dealing with insurance can sometimes be a complex process involving copays, deductibles, pre-approvals, and paperwork. Paying out-of-pocket can be much simpler.
If you would like to make an appointment, use the button below. Continue reading to find out about out of network benefits or help with network submissions.
Out-of-Network Benefits?
Navigating out-of-network benefits can be confusing. Ask your insurance provider about coverage, costs, and claim submission procedures for clarity.
Out-of-Network Reimbursement
If you have a PPO insurance plan, it might reimburse 50-80% of the session cost once you’ve met your out-of-network deductible. Your deductible is the amount you need to pay out-of-pocket before your insurance starts covering a percentage of the costs.
To check your out-of-network benefits, call the number on the back of your insurance card and ask these questions:
- Do I have out-of-network benefits for outpatient mental health care?
- What is my out-of-network deductible for outpatient mental health visits?
- How much of my deductible has already been met this year?
- What is my out-of-network coinsurance for mental health?
- Coinsurance is the percentage of the service cost you pay after meeting your deductible.
- Do I need a referral from an in-network provider or my primary care physician to use out-of-network benefits?
- What is the reimbursement rate for these services? (Provide the representative with these CPT codes for reference):
- 90791: New patient evaluation
- 90834: 45-minute psychotherapy session
- 90837: 60-minute psychotherapy session
- 90847: Family therapy with the patient present
- 90846: Family therapy without the patient present
- Do I have coverage for telehealth appointments?
- How do I submit claims for out-of-network reimbursement?
Special Cases for In-Network Exceptions
If your insurance plan doesn’t include out-of-network benefits but doesn’t have any in-network providers who can meet your specific needs (e.g., treating young children under 5), your insurance might still reimburse for out-of-network care. Call your insurance company to ask if this applies to you.
Do you need help with out of network submissions?
If you want to avoid the legwork to submit your out-of-network claim, we have partnered with Reimbursify. Your initial submission is free, but after that their is a small fee per submission. We don’t need receive any compensation from Reimbursify. If you’d like to submit to Reimbursify, please click the “R” button on this page.
Have More Questions?
We're here to help you on your journey to a brighter day. Contact us today to learn more about our services and how we can assist you.