Rates and Insurance

Self-pay rates:
Initial session (60 minutes) – $150
Follow-ups (45-50 minutes)- $125

Not sure what a fair cost for therapy is?  Check out  Healthcare Bluebook and Fair Health Consumer.  Type in your zip code and search for ‘psychotherapy 45 minutes’ or CPT code 90834; or ‘psychotherapy 60 minutes’ or CPT code 90837.

Due to legal and ethical requirements, clients are not allowed to carry account balances as doing so can muddy the waters of clinical work. This means that full payment is due at the time of service. For therapy, this means the cost of therapy is due at the end of each session.

Reduced Fees:
I understand that not everyone is able to afford the full therapy rate, and will work with you to find an affordable rate within your means. We offer this on a case-by-case basis depending on hardship or household income. (Proof of income is required)

Insurance:
At this time, I’ve decided to not accept insurance.  This is a boutique-style private practice that seeks to offer high quality, individualized attention to each client and is firmly committed to each person’s privacy and confidentiality.  I can’t meet those goals being in-network with insurance companies.  {Plus, I went into this field to help people, NOT help insurance companies and their investors make money.}
If you’d like to use your insurance coverage, you may still be able to work with one of our providers if your insurance plan has out-of-network (OON) benefits. Read on below, or call me and I’ll be happy to help answer your questions.

Out of Network (OON):
Your insurance plan may have out-of-network (OON) coverage.  If it does, you may be able to work with me using it.  Trust me – it’s super easy!  Here’s how it works:
You pay me directly and I provide you with a monthly statement of services (called a superbill).  Then, you submit (e-mail, fax, or snail mail) it to your insurance company if you decide to seek reimbursement through your insurance company’s out-of-network coverage. Your insurance company will process the superbill and will: apply the amount you’ve paid to chip away at your deductible, or reimburse you a percentage if you’ve already met the deductible. Just to be clear, Medallion Counseling and Counseling makes no guarantees that you’ll receive reimbursement (or how much reimbursement) from your insurance company.

How to determine if your insurance plan has out of network coverage?
Call the customer service phone number on the back of your insurance card so you can ask questions about your coverage and make an informed decision before getting started with counseling.  Here are some helpful questions to ask the representative:

  • Do I have out-of-network mental health benefits?
  • If they say yes, ask: What is my out-of-network deductible?
  • Then ask: Is this deductible combined with my in-network deductible, or is it separate?
  • Then ask: How much of this deductible has been met to date?
  • Then ask: Are out-of-network services by a licensed clinical psychologist covered?
  • If I have out-of-network benefits, do I have to select a mental health provider from a list or can I choose any provider?
  • What is my co-insurance for outpatient psychotherapy with an out-of-network therapist once my deductible has been met? (This is usually a percentage.)
  • What is my out-of-pocket maximum? How much of it has been met to date?
  • Is pre-approval required under any circumstances before obtaining out-of-network outpatient mental health services to be reimbursed?
  • Will I be reimbursed the % on the full amount I paid (aka reasonable and customary fee) or only a portion of the amount (aka allowable amount)?
  • For psychotherapy, ask: Do you cover procedural codes 90834 (45-min session) and/or 90837 (60-min session)?
  • For psychotherapy, ask: Is online therapy by a licensed clinical social worker covered?
  • What is the process for seeking reimbursement for out-of-network claims? Do I have to fill out a special form? Do I mail, email, fax, or submit my documents through an online portal?
  • How long do I have to submit out-of-network claims?

 

Cancellations:
I ask for a minimum of 24 hours’ notice if you need to cancel a session.  A cancellation fee will be charged to the credit or debit card on file if you fail to attend a scheduled session or give less than 24 hours’ notice of cancellation.

 

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