I have chosen to remain an “out-of-network” provider for all insurance companies. In my experience, this allows me to provide a higher quality of care, independent from insurance-based rules or decisions. Accordingly, full payment is due from you at the beginning of each therapy session. I accept payment by cash, check or credit card.
It is your choice whether you would like to apply for insurance reimbursement or not. Although I do not accept direct payment from insurance companies, I provide a “super-bill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the super-bill to your insurance company for reimbursement. Please note that I do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.
Superbills are automatically generated in the client portal after the first day of the month following the appointment. You can log in and download the super-bill at your convenience.
DIAGNOSIS IN COUPLES THERAPY:
For couples therapy, most insurance companies will reimburse for therapy involving two people if one person has been given a diagnosis. We should have a discussion to make sure the appropriate partner is provided with a diagnosis.
QUESTIONS TO ASK YOUR INSURANCE PROVIDER:
To find out more about your coverage, call your provider, get the name of the person you’re speaking to, and ask the following questions:
Does my policy cover out-of-network outpatient psychotherapy?
CPT CODES: If yes, what is the reimbursement for out-of-network psychotherapy services for the following CPT codes: 90834, 90837, 90847. What is the reimbursement rate for telehealth CPT codes, 90834-95, 90837-95, and 90847-95? Your insurance company should understand what a “CPT code” is, and whether they reimburse for these specific codes.
Is there a maximum number of psychotherapy sessions for which they will provide reimbursement?
DIAGNOSIS CODES: Will the insurance company reimburse for the following diagnoses (which are common for my clients to have): adjustment disorder, PTSD, generalized anxiety disorder, major depressive disorder, dysthymic disorder, autism, and agoraphobia with panic disorder?
For couples therapy, the most common diagnosis by far is "adjustment disorder", which means you are experiencing stress (relationship difficulty) which is causing significant problems in your life.
While some clients may have additional diagnoses, the ones listed above are the most common ones used in my practice, and it is helpful to know ahead of time if the insurance company will be willing to reimburse for the ICD-10 codes attached to these diagnoses.
% REIMBURSED: If your insurance company reimburses a percentage of the cost, what is that percentage, and what is the maximum cost per session they are allowing?
For instance, they may reimburse 70% of a psychotherapy session (CPT code 90837), but assume that the maximum rate of the psychotherapy session is only $120 (instead of my actual rate). This would mean the client would be reimbursed $84 per session. Another insurance company, however, may only reimburse 50%, but allow a $250 hourly rate, meaning that the client would be reimbursed $125 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.
Is a doctor’s referral required and/or is pre-authorization required? What is the name and number of the person to be contacted for pre-authorization?
DEDUCTIBLE: Is there a deductible and how much is it? Is it a yearly deductible? How much of the deductible do I have left over to meet?
ADMINISTRATIVE: What is the address of the office where I should send my claims? To whose attention is the claim to be sent?
HSA AND FSA ACCOUNTS:
Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.
I understand that financial concerns may lead you to use an in-network provider. Please be aware that there are local non-profit agencies that provide low-cost counseling services.