We appreciate how confusing and stressful it is to navigate the insurance reimbursement process and are working towards identifying ways to make this process easier for our clients to reduce the barrier to accessing quality mental healthcare. In the meantime, we strive to fully answer your questions and address your concerns with the following information. Should you have outstanding questions, please do not hesitate to contact us.
We are out-of-network with all insurance plans including Medicare and Medicaid. Payment is due at the time services are rendered. You can pay in the form of credit card, Health Savings Account (HSA) or Flexible Spending Account (FSA).
Not to fear! Our services qualify for reimbursement under most insurance plans. People are often surprised to learn that they have out-of-network coverage and typically receive reimbursement for 50-80% of therapy fees. We provide you with an itemized medical receipt (i.e., superbill) that you can submit for direct reimbursement via your insurance plan. Please note that you might have an initial fee (i.e., a deductible) that your insurance company will ask you to pay before they begin sending you reimbursement, but this differs across each person’s plan.
If you are interested in using out-of-network behavioral health benefits, we strongly recommend that you call the phone number on the back of your insurance card to learn about your mental health benefits and coverage prior to your initial appointment with us.
If cost is a concern, we offer reduced frequency of sessions when appropriate such as meeting biweekly, every 3 weeks or monthly.
Helpful questions to ask include when inquiring about reimbursement for out of network benefits:
- Does my plan cover mental health visits over telehealth? Do I need preauthorization to receive services?
- Do I have out-of-network coverage? Do I have a deductible that I have to meet prior to out-of-network coverage? If so, what is it?
- What forms do I need to submit in order to get reimbursed?
- Individual sessions: What is your reimbursement rate for out of network procedure CPT codes 90834 and 90837?
- Family sessions: What is your reimbursement rate for out of network procedure CPT code 90847?
Pre-surgical Psychological Assessment
Most insurance companies will only cover a psychological evaluation if it is deemed medically necessary. Having a medical doctor make a referral (e.g., surgeon, psychiatrist, neurologist, physiatrist, primary care physician) can help with the insurance company’s willingness to reimburse for part of these services. It is important for you to call the number on the back of your subscriber identification card to inquire about coverage for pre-surgical psychological assessments. When you call, be sure to specify the reason for the evaluation.
Ask if you are eligible for reimbursement for out-of-network psychological evaluations, and if so, whether you need “pre-authorization.” The following are some of the CPT codes used for these services: 90791 (clinical interview), 96136 (testing per 30 minutes), 96130 (scoring, interpretation, feedback, and writing).
- 50 minute Individual Follow Up Appointment for Adults and Adolescents - $240
- 50 minute Family Follow Up Appointment - $270
- Pre-Surgical Psychological Evaluation – $288 per hour; evaluations typically range between 3.5 to 4.5 hours depending on case complexity. The evaluation process includes an in depth clinical interview where information regarding your medical and psychological history, psychosocial stressors, goals, expectations, and health variables and behaviors will be collected as well as emotional and/or cognitive measures. The psychologist will then write the report, which will be shared with you. The results will be reviewed and there will be an opportunity to discuss any outstanding questions or concerns.