I currently bill insurance as an out of network provider. I am paid directly by you, and then will provide you with an invoice detailing dates of service, payment made, and relevant codes related to diagnosis and type of treatment (e.g. individual vs. family). Please note that a mental health diagnosis is usually required for insurance when they provide reimbursement. The person of focus for the treatment (e.g. child or adult) is the one who is given a diagnosis. There is not always a relevant mental health diagnosis for some of the issues I work with families on.
My Fees:
I offer a 3-tier payment system for all of my clients. Clients self-identify (no need to fill out any paperwork about your finances) which tier fits their current family’s resources. I believe that if everyone pays what they can, when they can, I am able to serve families of different means.
Full Fee: $250 per intake session; $185/ 50-55 minute session
Reduced Fee: $165 per intake session; $135/50-55 minute session
Limited Fee: $120 per intake session; $75/50-55 minute session
Note that the above ranges are guidelines. You are welcome to pay what works for you within the ranges (e.g. $125/session or $90/session). Please inquire if these fees are still out of range. I do not always have openings at each fee level. Please check with me prior to our intake to be sure I have openings that fit your current needs. I currently accept check/cash or payment with cards through my client portal.
Questions for your insurance company
I strongly encourage families to check into their mental health benefits prior to engaging in services. The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. You should have a number on your card or on the website that will tell you whom to contact.
Do I need a referral from my primary care physician to a mental health professional? Many insurance companies, especially Health Maintenance Organizations (HMOs) require referrals from a primary care physician to visit any specialist, including mental health professionals.
Do I need any pre-approval from the insurance company before I see a mental health professional?
A referral is an authorization from a doctor saying that the treatment is medically necessary;preapproval or pre-authorization requires that your insurance company agrees to make the payment. You should call your insurance company to see if you need pre-approval, but you should also keep other questions in mind-how many visits are you approved for? Do you need a new approval for each visit?
Do I need to see a mental health professional who is on a list provided by my insurance company (in a “network”) or am I free to choose any qualified professional?
If you need an “in network” provider, you can usually find a directory online or ask your primary care physician to help pick someone out.
Does the amount paid by my insurance company depend on whether I see a professional who is “in their network or preferred provider list” or “outside the network”? If so, what is the difference in the amount paid or percent reimbursement for “in network” vs. “out of network” providers?
“In network” providers are almost always cheaper than “out of network” providers, although whether you want to save money or visit a doctor you prefer is a choice you will have to make. Bear in mind that your insurance company may not always have a flat difference. For some companies, seeing an “in network” provider may cost you a $20 co-pay, and an “out of network” provider will cost you $30; in others, “in network” may cost you $20 and an “out of network” may cost you 20% – which could be significantly higher than $30. NOTE: I am considered an “out of network” provider.
Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?
Insurance companies often have the option to not include certain diagnoses in all policies. If you applied with your condition as a pre-existing condition, they may not cover anything related to that. Your insurance company will provide you with a list of covered and uncovered diagnoses. Generally insurance companies cover individual diagnosis such as generalized anxiety disorder, or adjustment disorder. They often will not cover a diagnosis such as parent/child relational issues or couples therapy.