Insurance can be confusing!
Our insurance lineup:
In-network vs Out-of-network:
Many people think they need to see someone who is in-network with their insurance. This is not necessarily the case. Out-of-network simply means the therapist does not have a contract with your health insurance company. Conversely, in-network means that your provider has negotiated a contracted rate with your health insurance company. You can call your insurance’s customer service phone number on the back of your card to find out what your in- or out-of-network benefits are.
When calling your insurance company:
First, look on the back of your insurance card for the customer service phone number or behavioral health phone number. (You probably already know this, but it can be confusing!) When you call this number here are some great questions to ask:
Is [your provider’s name] in-network for me?
If they are out-of-network, what are my out-of-network benefits?
Can I get an authorization for [your provider’s name] to be in-network for me?
How much does an out-of-network session get reimbursed for?
How many sessions are covered in a year?
What is my deductible status?
Do I have separate deductibles for in-network services and out-of-network services?
Will I need to pay a copay for sessions with [your provider’s name]?
Deductibles, Out-of-Pocket Max, and Co-pays:
Your deductible is the amount you need to pay before insurance starts to help out. After your deductible is met, your services will either be covered partially or fully. Each plan is different, so make sure to check what yours is.
Your out-of-pocket max is an amount set by your insurance company that you have to reach before they cover services at 100%.
Some plans will also require a co-pay for services. A co-pay is a fixed amount you pay for a covered health service. If you have a co-pay you will pay that amount each session.
Getting reimbursed for out-of-network services:
If we are out-of-network with your insurance company, we will ask that you pay for sessions up front. We will provide you with a paid invoice (“superbills”) for you to submit to your insurance for reimbursement. Your insurance will determine whether or not to approve the claim depending on your benefits, and how much you will be reimbursed. We recommend you check your insurance benefits prior to your first session.
EAP Appointments
Some work places offer their employees access to Employee Assistance programs (EAP). EAP appointments are typically paid in full by the EAP, which maybe a different insurance than your regular health care benefits. EAP appointments often require approval from your Human Resource department and/or the insurance prior to your first appointment. Your HR will approve a limited number of sessions and provider you with an authorization code to give to your provider. EAP session are intended to help clients restore their work-life balance and restore work functionality. These sessions focus more on short term coping skills and increasing motivation, so that employees can successfully return to work.
Paying a co-pay or for an out-of-network session:
We accept checks, cash, debit, and credit cards, including HSA, FSA and HRA. We will likely ask that you provide your debit or credit card information, which we will keep on file and charge for these automatically.
I still don’t get it…
No worries! We’re here for you! Please talk with your provider either before starting (with a free consultation) or during your intake appointment about any insurance questions/concerns. We are happy to help walk you through it.