"Every passing minute is another chance to turn it all around." ~Sofia in Vanilla Sky
Insurance and Session Costs
If you ready to face things that are holding you back, dig deep, and make changes, then you will give yourself the best gift of all! You will be improving your inner world, feel happier and more content, improve your relationships, and get the most out of your life. I can't wait to help you achieve your therapeutic goals and to start working with you. However, in order to do this, it has to be affordable! I understand that the session fees can add up; therefore, I have a couple of ways that I can help make sessions more affordable.
- My standard fee for a 45 minute Individual Adult, Sex therapy, Couples Therapy, or Parenting Consultation session is $250 (this may vary by office location). If you have out-of-network insurance benefits, you may be reimbursed for part of all of the session fee. Please see below to know how to estimate your session costs.
- My standard fee for a 60-minute PCIT/ PMT session is $300 (this may vary by office location). If you have out-of-network insurance benefits, you may be reimbursed for part of all of the session fee. Please see below to know how to estimate your session costs.
Insurance
I can submit to most major insurance plans and have on occasion have accepted:
- Aetna
- BlueCrossBlueShield
- Cigna
- Oxford
- UnitedHealthCare
- and more...
IN-NETWORK
I am usually considered out-of-network. However, if I am in-network for you based on your insurance carrier, your employer's arrangement with the insurance company, a special arrangement with you/ your insurance company, and the specific plan you selected, session costs will range from $0 - $150/session depending on your specific plan and benefits. The session costs are completely set by your insurance company. People usually pay $30-$60/session once their deductible has been met. Please be aware that actual plans and prices vary. For those using a Health Flex Spending Account (FSA, HSA, or HFSA), sessions will cost $25-$45/session on average.
OUT-OF-NETWORK
I am usually considered out-of-network. If I am out-of-network based on your insurance carrier, your employer's arrangement with the insurance company, my arrangement with you/ your insurance company, and the specific plan you selected, sessions costs will range from $0 - $250/session (or $0-300/session) depending on your specific plan. Most patients end up paying about $50- $75/session (20% or 30% coinsurance respectively) once their deductible has been met. For those using a Health Flex Spending Account (FSA, HSA, or HFSA) sessions will cost $40-$60/session on average.
**Below, I have detailed information on how to determine your actual session costs. I wanted to make this process transparent and accessible for people.
SUBMITTING SESSIONS TO INSURANCE and FSA's/ HFSA's
At this time, I am able to submit to most insurance companies on your behalf. If I am not able to submit to your insurance plan for some reason, I will give you a receipt called a SuperBill that documents our sessions, diagnosis, and payment, which you can then submit to your insurance company.
Unfortunately I cannot bill or accept payment from any HFSA or FSA. However, if you have a FSA or HFSA, please let me know and I will provide you with a SuperBill that you can submit to be reimbursed for session costs at a discounted (pre-taxed) rate.
Insurance can be incredibly CONFUSING even for professionals. Please feel free to discuss any questions or concerns regarding insurance with me and I will help break it down for you.
Insurance
I can submit to most major insurance providers to help you receive some help with session costs but I do not accept payment from them. All reimbursements and payments will be sent directly to you. There are some insurance companies I cannot submit to, but will provide you with the paperwork to submit yourself. I also offer low fee and sliding scale fees to help make the sessions and working together possible for you; after all, you can only benefit from the work we could do together if you can attend the sessions!
If you plan to use insurance to help cover the cost of sessions, please email me photos of both the front and back of your insurance card along with your Date Of Birth (DOB) - this allows us to have better estimated session costs rather than discussing hypotheticals. Before our first meeting, I will contact your insurance carrier to confirm insurance coverage, inquire about your specific benefits, and the reimbursement rates for CPT Codes 90791 (Intake), 90834 (psychotherapy for an individual and/or family member), 90847/90846 (family therapy), and 90839 (crisis) prior to our first meeting.While these amounts are quotes and estimates, they may not be a guarantee of coverage or benefits. We will know the official rates once we receive the EOB (Explanation of Benefits). You are responsible for anything insurance does not cover.
** Due to increasing difficulty and barriers in getting through to a representative of insurance companies, I now recommend that you call your insurance company to inquire about these CPT codes and your benefits. As their client, you will likely have more success in accessing your benefit information than I will as a provider. There are a few places for you to quickly check your benefits:
- Log on to your insurance's member services portal and look for your out-of-network benefits, specifically, write down your 1) deductible, 2) coinsurance percentage, 3) Max out-of-pocket (Max OOP) amount, and 4) any telehealth benefit details.
- Call the member services phone number on the back of your card. Below, there is a list of questions for you to ask the representative on the phone. Have that handy to make sure you cover all the relevant/ necessary info!
- Reference the most recent insurance enrollment PDF you have and look for your out-of-network benefits, specifically, 1) your deductible, 2) coinsurance percentage, 3) Max out-of-pocket amount, and 4) any telehealth benefit details.
** Please retain the information and numbers quoted by your insurance provider along with a call reference number - I will need them to fill out in your profile if we end up working together!
To try to help facilitate your conversations with your insurance and to help you get the information you need to make your decisions, below is the list of questions I have ready when verifying a patient's insurance coverage and benefits for "routine outpatient mental health in an office setting". When calling your insurance carrier to confirm your coverage and benefits for "routine out-patient mental health services in an office setting", ask these questions for out-of-network services:
- Deductible Amount for Individual:
- Deductible Amount for Family:
- Copay Amount:
- Coinsurance Amount (your percentage and insurance's percentage):
- Max Out of Pocket Amount for Individual:
- Max Out of Pocket Amount for Family:
- Year to Date Accumulations toward Deductible Amount for Individual:
- Year to Date Accumulations toward Deductible Amount for Family:
- Year to Date Accumulations toward Max Out Of Pocket Amount for Individual:
- Year to Date Accumulations toward Max Out Of Pocket Amount for Family:
- When does the plan and deductible renew?
- Do you need preauthorization?
- Is there a limit to the number of sessions per calendar year?
- Do these benefits apply to telehealth and teletherapy sessions?
CALCULATING YOUR BENEFITS
This is how to to calculate it all...
For example, I will use my usual $250 fee and apply it to the deductible, coinsurance, and Max Out Of Pocket (Max OOP). For the purposes of our example, lets' say you have really great insurance (thank your employer):
- a $1000 deductible
- a 30% coinsurance
- a $3,000 Maximum Out Of Pocket amount (Max OOP).
First, take the deductible and divide it by your session cost ($1000 deductible divided by $250 per sessions = 4 sessions). Therefore you could estimate that your deductible would be met in 4 sessions.
Next, look at the coinsurance. A coinsurance is basically the same as a copay - it is the amount you are responsible for each session after your deductible has been met. The only difference between a copay and coinsurance is that a coinsurance is a percentage whereas a copay is a fixed amount. So in the example above you have a 30% coinsurance, it would then end up being $75/ session after insurance reimbursement ($250 multiplied by 0.30= $75) .
Last, calculate if/ when you should reach your Max OOP amount. To do this, take the Max OOP amount, subtract the deductible, and then divide that amount by your coinsurance. ($3,000 Max OOP - $1,000 deductible = $2,000. Then $2,000/$75 coinsurance = 26.6667 sessions). Then add the number of sessions for the deductible plus the number of sessions for the remaining Max OOP amount (4 sessions for the deductible + 26.6667 sessions for the coinsurance = 30.6667 sessions). This should be the number of sessions until your cost per session should become $0. Therefore, sessions 31 and beyond should be $0 for the rest of your insurance contract period (typically renews on Jan 1st but plans vary by your employer). Unfortunately, insurance companies are misleading with their contracts, actual coverage amounts, and sometimes do not follow this math, but that is how the math is supposed to work.
Insurance can be incredibly CONFUSING even for professionals. Hopefully this helps you with your understanding of your benefits. Please feel free to discuss any questions or concerns regarding insurance with me and I will help break it down for you.
Low Fee and Sliding Scale Options
I understand that therapy is a financial commitment. You are spending your money, time, and energy working to understand yourself and improve your life. You have to be able to attend sessions on a consistent basis (weekly or more) to get the results you want. After all, you can only benefit from the sessions if you can attend them! Therefore, when appropriate, I use a sliding scale fee to help make sessions more affordable to you. A sliding scale is used to help people have access to health care they otherwise would not be able to afford. I reserve a certain amount of my schedule for sliding scale appointments. I set aside a certain amount of my caseload for these people. If you believe a sliding scale applies to you, please bring it to my attention so we can discuss it further.
Another method I have used to help lower costs of sessions for a select percentage of my caseload people is to accept assignment, payment, and the rates set by their insurance company for out-of-network providers. This is to help decrease the upfront cost and is a way that I can ensure equity and allow access to mental health services for those who may want it but have barriers to access of mental health services. I set aside a certain amount of my caseload for people who need this option. If you believe this option would benefit you, please bring it to my attention so we can discuss further.
COVID Notice
Due to the COVID pandemic, all sessions are currently being held virtually via live video feed. I offer telepsychology to residents living in the following states:
AL, AR, AZ, CO, CNMI, CT, DC, DE, GA, ID, IL, IN, KS, KY, MD, ME, MI, MN, MO, NC, ND ((effective 8/1/23), NE, NH, NJ, NV, OH, OK, PA, RI (effective 7/1/23), TN, TX, UT, VA, WA, WI, WV, WY