INSURANCE


The Anxiety and OCD Treatment Center, LLC is a fee-for-service provider.

As a private practice of licensed psychologists and therapists, our professional services do qualify for reimbursement under many insurance plans. Clients who have out-of-network benefits as part of their insurance coverage can utilize their benefits for treatment. In that instance, clients pay for each session in full at the end of the appointment and then submit monthly "superbills" to the insurance company. Depending on the deductible and other particulars of the plan, clients will receive a direct reimbursement from the insurance company for some portion of those fees.


We recommend you check with your insurance company to determine the potential for reimbursement prior to scheduling an appointment. The following are questions to ask your insurance company:

  • Do I have out-of-network mental health benefits?
  • Do I have a separate deductible for out-of-network mental health services?
  • Do I need a pre-authorization for out-of-network mental health services?
  • What are the “reasonable and customary” rates in the 19810 zip code for the initial evaluation session (CPT code 90791) and for ongoing sessions (CPT code 90834, 90837 and 90847)?
  • What percent of the “reasonable and customary” fee do you reimburse for out-of-network mental health services
  • How do I submit my own claims for reimbursement?

Health Spending and Flexible Spending Accounts


Many of our clients also utilize their Health Spending Accounts (HSAs) and Flexible Spending Accounts (FSAs) to cover the costs of therapy. It is an excellent option for payment as both accounts are tax advantaged. We urge you to verify this with your insurance plan provider.

Insurance Frequently Asked Questions


Do you accept Medicare or Medicaid?  We are not a provider for Medicare or Medicaid.


Is it possible I am eligible for partial reimbursement from my insurance plan? Yes, if your insurance plan includes out-of-network coverage. 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 “reasonable and customary rates.”


What is a “reasonable and customary 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 rate for a licensed psychologist might be $125.00, $150.00, or some other amount
  • The allowable rate for a licensed professional counselor might be $70.00, $80.00, or some other amount
  • Note- in most instances, the reasonable and customary rate will 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/hour. 

  • Your insurance plan will reimburse 60% of the allowable rate which they set at $120 ($120 x 60% = $72)
  • Out-of-pocket expense (once the deductible is met): $150 - $72 = $78/session

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.


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.

RATES


Licensed Psychologist

  • (CPT 90791) Extended Ninety-Minute Initial Evaluation:  $300.00
  • (CPT (90791) Sixty-Minute Initial Evaluation:  $235.00
  • (CPT 90837) Sixty Minute Psychotherapy Session:  $200.00  
  • (CPT 90834) Forty-five Minute Psychotherapy Session:  $150.00
  • (CPT 90832) Thirty Minute Psychotherapy Session:  $105.00


Licensed Counselor 

  • (CPT 90791) Initial Evaluation:  $155.00 
  • (CPT 90837) Sixty Minute Psychotherapy Session:  $140.00
  • (CPT 90834) Forty-five Minute Psychotherapy Session:  $110.00 0
  • (CPT 90832) Thirty Minute Psychotherapy Session:  $75.00


Doctoral Level Practicum Students (fees for doctoral students are not submissible to insurance for reimbursement)

  • Initial Evaluation:  $60.00
  • Sixty Minute Psychotherapy Session: $50.00
  • Forty-five Minute Psychotherapy Session: $40.00 
  • Thirty Minute Psychotherapy Session: $30.00



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