Out of Network Benefits

 

I am not a participating provider with any insurance company. Therefore, you are responsible for the full payment for each session at the end of each session.

I do not have a sliding scale fee available at this time. 

You may pay for your psychotherapy sessions by check or cash. You may also pay using VISA or MASTERCARD debit cards (including Flex Spending Account debit cards); and VISA, MASTERCARD, AMERICAN EXPRESS or DISCOVER credit cards at no additional charge.

If you have a Preferred Provider Organization (PPO) or Point of Service (POS) medical health plan, you may be eligible for partial reimbursement of your psychotherapy sessions, after meeting an out of network deductible. The specific amount of your Out of Network deductible and the percentage of partial reimbursement depends on your specific medical plan.  Partial reimbursement is based on a usual and customary fee (UCF).  The UCF for a 60-minute session is typically close to $133. Please note that not all diagnoses are eligible for reimbursement.

So, if you are working with me in individual psychotherapy (60-minute sessions), and have a $500 deductible, you would be eligible for partial reimbursement beginning with the third 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 60-minute session (after reimbursement) would be $79.

As a courtesy, I will submit electronic claims on your behalf if your insurance company allows this. If not, I will give you a monthly statement that you will be able to submit to your insurance company for reimbursement of payments paid for psychotherapy sessions.

Iit is your responsibility to contact your insurance company to find out about your Out of Network deductible and the percentage of reimbursement that you are eligible for.

Here are a list of questions that you will need to ask when you contact your insurance company:

  • What is my out of network deductible?
  • What is the percentage of reimbursement for out of network mental health outpatient sessions (CPT code 90837, 60-minute Individual Psychotherapy or CPT code 90853 for Group Psychotherapy )
  • Are telehealth (video/online with HIPAA compliant software) psychotherapy sessions covered?
  • For the purposes of my out of network deductible, when does my year begin-January 1 or another date?
  • What is my annual out of pocket maximum?
  • Can electronic claims be submitted by my psychologist? If so, what is the Payer ID number for the submission of electronic claims?

I am happy to answer any additional questions during your free 20-30 minute phone consultation.