More about Insurance
It is important to make an informed decision about using your insurance benefits to pay for individual therapy. Here are some key things to consider:
Insurance companies require a mental health diagnosis code to meet medical necessity. This becomes a part of your permanent medical record.
Insurance plans may have limitations on the number of sessions that they will cover per benefit year. Any sessions beyond that number will have to be paid out of pocket.
Any documentation that I may have of our sessions together may be subjected to an insurance audit, which I would be required to provide.
I use Headway to manage insurance billing and admin work to make things as easy as possible for you. I will create a profile for you on their site, and you will receive an email from the Headway team to set up your account, add your insurance and payment details for any co-pays due. You’ll see your cost per session ahead of time and can check your benefits any time on their site.
Questions to Ask About Using Out of Network Benefits
Does my plan cover out of network mental health services in an outpatient setting?
Not all plans include out of network coverage for mental health services.
What is my deductible?
Your deductible is how much money you need to spend out-of-network before your benefits will kick in.
How much of my out-of-network deductible has already been met?
Finding out how much of your out of network deductible you've already met will tell you how how much more you need to spend in order to meet it. For example, if your out-of-network deductible is $1,000 and you’ve already spent $850, you will only need to spend $150 more before your out-of-network benefits kick in.
What is the the covered calendar period of my policy?
The start and end date of your policy will help you determine how much time you have to meet your deductible. So if your plan is effective Feb 1 - Jan 31, if you're starting therapy on Mar 1, chances are you may have some time to go before meeting your deductible.
What is my co-insurance?
This is how much the insurance company will reimburse you for each session after you've met your deductible. If your co-insurance is 60%, this means you will be reimbursed 60% of a $150 session fee. This means it cost you $60 or that session.
What is the process to submit for reimbursement and is there a time frame to submit a claim?
You are responsible for payment of my full session fee at the time of service. I will create a "superbill " at your request (an invoice of services provided and the associated fees that must include a diagnosis code) which you will submit directly to your insurance company for reimbursement. I will specify on the superbill that reimbursements be sent to directly to you.
Depending on your plan, you may receive a portion of counseling fees reimbursed to you from their insurance companies. In some cases, you may not receive any reimbursement. Being reimbursed the full fee is extremely rare.