Fees & Payment -

Your care is worth the investment, but be informed when deciding to seek service.

 

How is therapy or coaching paid for? Generally speaking there are three ways to pay for service:

 

  1. Fee for Service or "out of pocket/private pay”: The client pays the therapist or coach directly. This allows you to have control over who you see, the type and goals of therapy or coaching, how long services will last, and who has access to your private information. *Note that private pay is the only way to pay for coaching. Insurance only covers medically necessary treatment (i.e. - you must have a diagnosis to substantiate treatment).

  2. In-Network Insurance or “Third party payment”: You and your insurance company each pay for a portion of the service. Your portion is known as a deductible, and/or co-pay/coinsurance. To use third party payment, the therapist must have an agreement or be In-network with the insurance company (see info below). Third party payment gives the health insurance company some control over which therapist you see, the amount of money or time allowed for the therapy, and the type of therapy utilized. This may affect the goals of therapy, and for billing purposes, your confidential information. Once confidential information is sent to the insurance company, we cannot guarantee its privacy.

  3. Out-of-Network Payment: In some situations, when a therapist is not in your insurance company’s network, you can pay for the services directly, and then you can file to receive out-of-network benefits that are paid directly to you. (see the following for more information)

 

In each case, you are responsible for paying your portion for services the day of your appointment. You can discuss the advantages and disadvantages of each payment type with your therapist/coach and come to an informed decision that is best for you. When cost is an issue, you may need to use your health benefits to access services. We encourage you to call for more information if you are currently experiencing financial hardship. We never want someone to not seek the care they need because of financial limitations; we may be able to help and/or refer you to someone who can. 

Cost and Payment Policy

Methods of Payment: Cash, Check, Credit Card (MC, Visa, Discover American Express), Payment is due at the time of your session

 

Rates: For services not covered by insurance or EAP, we charge a flat rate of $125 for a standard session. (*subject to change by each independent provider's policy)

$125.00 for 60 minute initial intake session

$175.00 for extended initial intake session (75-90 min.)

$  65.00 per 30 minute therapy session

$125.00 per 38 – 52* minute therapy session (standard 45 min.)

$125.00 per 53 – 60* minute therapy session (standard 60 min.)

$175.00 per 75 – 90 minute therapy session (currently, this is only an option for those who are paying full fee without insurance)

*Why do we charge the same rate for 45 vs. 60 min. sessions? Frankly, these are limits developed by the American Medical Association (AMA) in consultation with the American Psychiatric Association (APA). Mental health providers billing insurance must follow the limits for the sake of maintaining universally recognized standards for face to face time. Furthermore, many insurance companies do not reimburse the corresponding codes equitably. Some insurance companies will not even allow a 53-60 min. session without additional private information being shared to justify need. We prefer the longer session for clinical efficacy and effectiveness. We believe a different pay structure (especially as it affects our private pay clients) is unfair to clients and clinicians alike.

 

Services are provided and billed by or on behalf of each independent provider. Services may be covered in full or part by your EAP or health insurance plan if accepted by your provider (see questions to ask above). 

 

**Please be aware that with any health plans, there may be deductibles and copayments for which you would be responsible (review your policy or call your company for more information).

Health Plans

*Please note that each provider may not accept each insurance plan)

Aetna

Anthem Blue Cross and Blue Shield

Cigna Behavioral Health (Cigna Healthcare)

Healthlink

Humana

Medicare

PAS (Personal Assistance Services)

Tricare West

United Behavioral Health (UHC/OptumHealth)

Beacon Health Options

 

*If your plan is not listed or the provider you wish to see is out-of-network, we can provide you with documentation that you can submit to your insurance company to request reimbursements (reimbursement for out-of-network benefits).

 

Questions to Ask Your Insurance Company

*You may be able to find information by clicking your company link in the column above left (Health Plans).

  • Does my plan cover mental health sessions?

  • Does my plan cover only individual psychotherapy or will it also cover family or couples counseling?

  • How many sessions does my plan cover in a year? How many sessions do I have left?

  • Does my plan cover services to out-of-network mental health providers?

  • What is the deductible I have to meet before coverage to an out-of-network provider kicks in?

  • What is my copay or what percentage of treatment do I pay when seeing an out-of-network mental health provider?

  • Is there a maximum amount per session the insurance will cover for an out-of-network provider?

  • How much time do I have to file a claim for out-of-network services?

  • Do I need pre-authorization or a referral from my PCP to see a therapist?

  • If I need pre-authorization, do I need to call or does my therapist?

  • What is the process to get reimbursed for out-of-network services?

 
Should I Use My Insurance Benefits?

Be well informed when deciding to use your health plan to cover therapy. The unfortunate reality is that seeking mental health care through your insurance can sometimes have unplanned consequences. Insurance companies only cover care that is "medically necessary". This means, that they will typically only cover therapy for issues that have a recognized mental health diagnosis attached to them. 

 

Your provider will be required to submit a diagnosis in order to get reimbursed for any therapy that you engage in. When submitting a claim to your health insurance, you permit your provider to provide the clinical information that the insurance company requires to substantiate the medical necessity of your care. Thus, your diagnosis and the supporting evidence for that diagnosis becomes part of your health record. Some feel this is a risk that could potentially impact other areas of life that take your health record into account. Please be sure to talk with your therapist about any concerns before moving forward with sessions. 

 

By choosing to not use insurance, you have more choice about who you see, how long you stay in therapy and what your therapy looks like. You also gain a higher level of privacy related to your health information.

 

When cost is an issue, you may need to use your health benefits to access services. Using health insurance may be the only way for you to get treatment. Ultimately, you can look at the advantages and disadvantages of each option and make an informed decision about what will be best for you.

© 2011-2020 Positive By Design LLC/David M. Harris, MSW, LCSW. All Rights Reserved.

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