Fees charged are generally based on $125 per session, but can vary. Fee arrangements will be discussed with your counselor at the time of visit.
When using insurance, a $100 payment is due at time of your initial visit, to be used pending insurance benefits
FEES AND INSURANCE EXPLAINED BELOW
Clients who do not have insurance are considered self-pay. Clients who do have insurance can still opt to self-pay for services rather than using their health insurance.
BENEFITS OF NOT USING HEALTH INSURANCE
While the theory of managed care can appear beneficial and is at times, there are many benefits to not using insurance for services:
Privacy: while HIPAA provides privacy and protection of your mental health records, using insurance means a level of confidentiality is compromised. This includes information that would otherwise be restricted between you and your therapist. All information submitted will become part of your permanent medical record. Self-pay for services eliminates this concern.
Creativity in Services: the approach we currently use for the treatment of mental health is highly linked to our medical model where you are “diagnosed” and “treated”. However, many see therapy as a tool to enhance personal growth, responsibility, relationship, and career satisfaction. With our continued understanding of emotional and psychological well being, our medical model approach is no longer relevant or even appropriate. Self-pay opens the door for more innovative ways to help you reach your goals.
Freedom: insurance companies limit the time allowed per session to less than one hour, which is often not enough time, especially when working through significant issues. Insurance companies also limit the number of times you can see a therapist within a certain period, usually one year. If more time or sessions are beneficial, paperwork must be submitted and a request for an authorization is necessary before proceeding. This process can disrupt the momentum of treatment while waiting for their response. Insurance companies then determine your needs, rather than you and your therapist.
Reduces Headaches: despite all efforts to file claims, submit paperwork, and provide necessary information, insurance companies can and do still deny claims. The claims must reflect a diagnosis code based on the DSM-V and may cause insurance companies to deny coverage due to being determined as not “medically necessary” despite efforts by the client and/or therapist that shows necessity.
Some clients use their health insurance benefits to cover services. Please note if you are using health insurance, this office requires a $100 payment up front at the time of client’s initial visit until which time benefits are determined. Any over or underpayment will be reconciled once insurance has come through.
All insurance claims and payments are subject to your benefits, deductible, and co-pay or co-insurance. Once all terms have been met, your insurance company will pay for services. However, keep in mind issues can occur relative to the acceptance and payment of claims, which include:
Effective Date: if there is any break in your effective date of insurance, you may see a denial. This means somewhere in the system they have flagged your policy as being inactive and therefore will not pay claims.
Health Information Request: your insurance is requesting health information from you and have not received it. When that happens, they will deny all claims until that information has been submitted.
Primary and Secondary Insurance Confusion: if you hold two different policies, there is confusion on which policy is your actual primary and which is secondary. Therefore, claims are denied until that is cleared.
Noncovered Services: when claims are filed for noncovered services, they will be denied.
Third Party Payor: some policies have partnered with a third party payor who is responsible for your mental health benefits. Furthermore, as health insurance continues to change, there are many more insurance companies. This office may or may not be in network with them. When that happens, claims may be denied.
Pre-Authorization Requirement:some policies require a pre-authorization prior to beginning treatment for services. If that pre-authorization has not been secured, claims will be denied.
[Note: this office will file claims based on the insurance card and/or pertinent information provided by the client. This office makes every effort to provide all necessary information. If, however, claims are denied or become an issue, it is the client’s responsibility to follow up. Any claims not paid by insurance will revert to the client for payment]
Definition of Terms
Deductible: your insurance policy has a specified deductible. This is a specific amount you must pay for all covered services before your insurance benefits will kick in. Your deductible can be any amount, depending on the policy you purchased. If you have not met your deductible, then payment for services will revert to you until that amount is fully satisfied.
Co-Pay: once your deductible has been met, you are then responsible for a copay amount to cover a portion of the services rendered.
Co-Insurance: once your deductible has been met, you are then responsible for a co-insurance amount to cover a portion of the services rendered.
[Note: you will either have a co-pay or co-insurance, you will not have both]
Secondary Insurance: clients may have both a primary and secondary insurance policy. Once a claim is filed with your primary insurance, secondary insurance benefits may apply. It depends on your policies and benefits.
[Note: please be advised this office does not file secondary insurance claims. It is up to the client to follow up. We can print a “Superbill” which provides necessary information for your secondary insurance company]