I am an out of network provider for most insurance companies. I can appreciate that attending therapy is both a time and financial commitment. I think it is important to understand your insurance benefits, therapy goals and types of treatment in order to make an informed choice. I would like to give you information to help your process at Wise Mind Counseling.
What does out of network mean?: Out of network reimbursement is often less than in network reimbursement, and the out of pocket expenses generally go toward one’s out of network deductible instead of in network deductible. Depending on your plan, you may still have insurance coverage (get reimbursed) for out of network services, and it is not guaranteed that out of network will cost you more. Not all therapy fees are set the same across counseling agencies. When using in network benefits at an agency with higher fees than an out of network provider, this could result in more out of pocket expenses overall.
What are the fees and how do I pay?: Fees are determined by the CPT code used in a session. CPT codes are standard codes used across mental health professionals when billing clients and filing claims with insurance.
The CPT codes and fees are as follows:
|90837 (60 minute session)||$205|
|90834 (45 minute session)||$155|
|90832 (30 minute session)||$105|
|90846 (Family therapy without patient)||$205|
|90847 (Family therapy with patient)||$205|
|90853 (Group Therapy)||$100|
Fees are due at the time of service. Cards are kept on file for convenient payment, and you can use your Health Savings Account. I will provide you with a statement after session called a Superbilll that you can submit to your insurance company for reimbursement directly to you (if your insurance company covers the services).
Questions you may consider asking your insurance provider:
1. Do you have out of network coverage?
2. What is your out of network coverage rate for any of the CPT codes above that you anticipate using in treatment? (not all insurance companies cover all CPT codes).
3. How will you submit the Superbill statement in order to receive reimbursement directly to you? (this is often done on their client portal).
4. How long will reimbursement will take? (so you know the out of pocket expenses to expect until reimbursement is received).
- Prior to intake, I will ask you to complete paperwork through the client portal. I will send you an email with all required paperwork.
- The intake assessment will take up to 55 minutes and will be a review of symptoms and goals for counseling.
- A treatment recommendation will be given for a type of therapy that most effectively treats symptoms. The frequency of sessions (weekly, bi-weekly, etc.) and duration of treatment (3 months, 6 months, etc) will also be recommended.
- A treatment contract will be agreed upon and will be re-assessed when the duration of time expires.
- You can expect treatment to be as efficient and individualized as possible!
Good Faith Estimate
Good Faith Estimate (GFE) is part of the No Surprises Act and you can find more information about it in my Privacy Packet. If you are not using your insurance benefits, you have the right to request an estimate at anytime.