I am an in-network provider for Advocate Aurora and Prevea 360. I am an out of network provider for all other insurance companies. I can appreciate that attending therapy is a time and financial commitment. I think it is important to understand both your insurance benefits and types of treatment offered to make an informed choice. I would like to give you information to help your process at Wise Mind Counseling.
What does it mean to be out of network?: I definitely recommend consulting with insurance as out of network benefits vary. Do not assume your plan won’t cover out of network services.
Some key differences with out of network vs. in network:
- Out of network reimbursement from insurance to the patient is often less than in network reimbursement.
- The out of pocket expenses (your sessions fees) generally go toward the out of network deductible instead of in network deductible.
What are the fees and how do I pay?: Session fees vary and are determined by the CPT code used per session. CPT codes are the standard set of 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 the 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 do you submit your statement (a Superbill) to receive reimbursement directly to you? This is often done on their client portal, mail, or fax.
4. How long will reimbursement will take? (so you can plan for the out of pocket expenses until reimbursement your 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 that will take about 30 minutes to complete.
- 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 at the end of the intake including the following: a type of therapy that most effectively treats reported symptoms, frequency of sessions (weekly, bi-weekly, etc.) and duration of treatment (3 months, 6 months, etc).
- A treatment contract will be agreed upon and will be re-assessed when the contract expires.
- You can expect treatment to be as efficient and individualized as possible!
- 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.
- Client forms: Wise Mind Privacy Packet and other forms can be found on the client portal.