Out of Network Benefits
I am not a participating provider with any insurance company. So if you have an HMO medical health plan, you will need to obtain a referral from your primary care physican to see an in-network mental health provider, or pay out of pocket for individual or group therapy sessions.
However, if you have a Preferred Provider Organization (PPO) medical health plan with Out of Network benefits, you will likely be eligible for partial reimbursement of your group or individual psychotherapy sessions.
For Out of Network services, you typically do not need a referral. However, you will have an Out of Network deductible that must be met before receiving partial reimbursement. Out of Network deductibles vary, as does the rate of reimbursement (30-90%), depending on your medical insurance plan.
A $500 deductible is not uncommon and insurance companies set "usual and customary fees" (UCF) for specific services. The UCF for 60-minute individual sessions is typically around $133.
So, if you are working with me in individual psychotherapy, and have a $500 deductible, you would be eligible for partial reimbursement beginning with the fourth session. If your insurance company reimburses at 80% of the UCF of $133, you would be reimbursed approximately $106 per session. This would mean that your net payment per session (after reimbursement) would be $44. If you were seeing an in-network mental health professional, your co-pay would typically be between $40 and $50 per session.
If you are participating in a grief therapy group and you have a $500 Out of Network deductible, you would be eligible for partial reimbursement of the remaining $250. However, if you have an Out of Network deductible such as $100, you would receive partial reimbursement of the remaining $675 of the cost of the group.
I am happy to contact your insurance company on your behalf to determine what your Out of Network deductible is and the rate at which you would be reimbursed. I also will submit electronic claims on your behalf or provide you with a monthly statement that you can submit to your insurance company for reimbursement of payments paid for individual or group sessions.
There is no additional charge for this service.