#1. Do you accept insurance?
We do not accept any insurance plans and we do not participate with medicare. However, depending on your insurance plan, you may be eligible to be reimbursed for a significant amount of the costs for therapy. If you have a plan that allows you to see “out of network” providers, sometimes called a PPO type plan, you ARE ELIGIBLE to be reimbursed for services out of network. We recommend that you call the number on the back of your insurance card and ask them the following questions to learn whether and for how much you can be reimbursed:
- Can I see an out of network therapist?
- If I pay for my sessions with an out of network provider, can I get reimbursed for those sessions?
- What is the reimbursement rate for these appointments? Is that rate based on a “usual and customary” amount for each session? What is your “Usual and Customary” amount for each of the CPT codes/services?
- Is there a separate deductible I must meet before out of network benefits will kick in? How much is that out of network deductible? How much have I already paid toward that deductible?
- The insurance company may ask what the “CPT” code is for the services. The following are the codes we tend to use most frequently:
- Individual therapy, 45 minutes, 90834
- Individual therapy, 60 minutes, 90837
- Couples/Family therapy, 90847
- Group therapy, 75 minutes, 90853
- Neuropsychological Assessment Services, 96132
The more common insurance plans in the area do allow for out of network services and will reimburse. Commonly, that amount is anywhere from 50% to 80% of our fees. The way it works is you will pay your therapist directly at the end of each session. You’ll get what is called a “superbill” which contains all the information needed to submit a reimbursement claim to your insurance company including the name of the therapist, our tax ID and NPI number and license number of the practice, your diagnosis code, and the codes for the specific services, called CPT codes. You’ll go online and fill out the appropriate claim forms and put the appropriate information from your superbill into the appropriate part of the claim. You’ll then click on the “submit claim” button. Be sure to check the box that indicates that the payment will be sent to YOU, NOT TO the provider. This is really important.
The amount you will be reimbursed is dependent on your plan, but let’s say your plan covers 80% for out of network services. This typically means they will reimburse 80% of the “usual and customary” amount. So if their “usual and customary” fee for individual therapy, 45 minutes–90834 is $100, you would get a reimbursement check for $80. Your out of pocket expense would be the difference of that $80 and whatever our fee is. For the sake of this example, if our fee is $180, and you get reimbursed 80% of the usual and customary $100, you would get $80 reimbursed of our $180 fee. Your out of pocket would be $100.
Why would anyone want to pay $100 out of pocket instead of paying their $40 co-pay?
Simply put, because it’s worth it! When you agree to see a provider who is “in-network” you should understand that the provider is essentially an employee of the insurance company and they have agreed to follow all of the insurance company guidelines in order to be considered in network. Those guidelines can be anything from what types of services they will provide, how often, and for what conditions. The insurance company controls the entire process of the therapy. So much so that in the middle of your treatment, the insurance company can decide that you’ve had enough and they will refuse to pay for more sessions. The provider cannot continue to see you in that case. It would be a violation of their contract. You see? The provider is working for the insurance company, not for you. The insurance company pays the therapist so the insurance company is the client.
We choose not to align with insurance companies because we want to work for our clients’ best interest, not the bottom line of insurance companies. We believe it is essential for the client and the therapist to have the final say of what treatment is and how it is done, not some insurance company middle manager.
We work for our clients. Not insurance companies.
#2. How do I figure out which therapist is a good fit for me?
We believe that fit is a vital part of the process of the work. With this in mind, please check us out online and look at our counselor profiles to see if one of us seems like a good fit. Please feel free to give us a call and we can chat on the phone a few minutes so you can get a sense of who we are.
Finally, book an initial session. We’ll agree to see a prospective client for an initial session just to see if the fit is mutually good. After 3-4 sessions, you’ll know on your end if the fit is good and so will we. After figuring that part out, we’ll discuss the plan for how to get your goals met that will include frequency of meetings and modality–what type of therapy is going to be most effective for you.
