Are you in my insurance network? Do you accept Medicare or Medicaid?  At this time, no. We are a fee for service, out-of-network provider and do not accept insurance.

I am a veteran and am concerned about payment. Do you have an option to help me?  We support our men and women in uniform. Lower cost treatment for posttraumatic stress disorder (PTSD) is offered for veterans and active duty persons suffering as a result of trauma connected to service or otherwise.

Can I use my Health Savings Account (HAS) or Flexible Spending Account (FSA) to pay for my sessions?  We urge you to verify this with your insurance plan provider. Many clients use their HAS/ FSA to pay for sessions. It is an excellent option for payment as both accounts are tax advantaged.

Is it possible I am eligible for partial reimbursement from my insurance plan for the sessions I have paid for or pay for in the future?  Yes. We urge you to contact your insurance provider to verify your specific benefits and out-of-network deductible. Some have a very low annual deductible ($500.00) while others have very high deductibles ($12,000.00). Once annual deductibles are met, clients receive between 10%-70% reimbursement for sessions based on “allowable rates.”

What is an “allowable rate”?  This varies by plan, but broadly speaking it is an amount set by your insurance provider relative to the type of provider by whom you are being treated.

  • For example, the allowable rate for a psychologist might be $110.00, $125.00, or some other amount for a 60-minute session.
  • The allowable rate for a licensed professional mental health counselor might be $40.00 or $50.00 or some other amount.
  • Note in some instances, the allowable rate may be lower than the rate we bill.

How do I compute my out-of-pocket expense?  Example: You see a Licensed psychologist whose fee is $150.00/hour. Your insurance plan will reimburse 60% of the allowable rate of $120.00 ($120.00 x 60% = $72.00)

  • Out-of-pocket expense (once the deductible is met) is $150.00-$72.00= $78.00/session

What do I need to ask when I call my insurance provider?  The questions you should ask include:

  • How much is my annual out-of-network deductible (dollar amount)?
  • What is the reimbursement rate for 60-minute outpatient psychotherapy if I see a licensed psychologist? If I see a licensed professional mental health counselor (LPMHC)?
  • Is preauthorization required for 60 or 90-minute psychotherapy sessions? (CPT Codes are: 90837 and 90837+99355, respectively)
  • What paperwork do I need in order to start a reimbursement claim, and where do I send it?

My insurance company said my plan requires Pre-authorization or Pre-certification. Can your office do that for me?  Yes. Sometimes pre-authorization must be done by the provider and we are happy to complete the necessary paperwork. Please remit all materials to be completed to your clinician at least 72 hours in advance of your first appointment. Please also note we do not enter into “single case agreements” with any insurance companies.

What do I need to submit to my insurance provider for out-of- network benefits?  You will need to submit a completed out-of-network claim form along with your session receipts. The claim form is different for different insurance providers. You should be able to find it online. If you need help filling out the form or would like us to look it over for completion, we would be happy to help you with that.

I will need an itemized statement to send them for a reimbursement claim. Will you provide that?  Yes. We are happy to provide this type of statement upon your request in hard copy or electronic format.

How long does it take to start receiving reimbursement from insurance?  It can take anywhere from a few weeks to two months to start receiving reimbursement from your insurance company. If you submit your claim electronically or by fax, it will take less time than by mail.