Plans will help you pay for therapy and other services we offer. It is important for you to understand that when you decide to use your insurance you are also choosing to reduce your privacy and also to have this become part of your medical history. If this loss of privacy is important to you personally and also for career purposes, you might want to pay for your counseling yourself, and in this case, we offer a sliding fee scale based on income and family size.

If you have mental health benefits coverage, your policy states that these benefits are conditioned upon “medical necessity” which means that we will be required to disclose a diagnosis based on your situation meeting the criteria as specified in the current edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. Many insurance benefits are limited to certain disorders listed in the DSM. Because health insurance is written by many different companies, we cannot tell you what your plan covers. Please read your plan’s booklet under coverage for “Outpatient Psychotherapy” or under “Treatment of Mental and Nervous Conditions.” Or call your employer’s benefits office or your insurance company to find out what you need to know.  

Many insurance plans have deductible clauses and co-payments. These amounts are due at the time of service. Although it is possible that mental health coverage deductible amounts may have been met elsewhere (e.g., if there were previous visits to another mental health provider since January of the current year that were prior to the first session here), this amount will be collected by us until the deductible payment is verified by the insurance company or third-party provider.

We are considered by most major insurance companies such as BlueCross/Blue Shield, CareFirst, Aetna and most major insurance companies as “in network or preferred providers”. If your health insurance has benefits for the type of therapy that we do, we will supply and complete all necessary insurance forms requested by your insurance company and other third-party payers at no additional charge to you. We will also submit them to your insurance company on your behalf at our standard therapy rate.  Your insurance company will determine the “allowable” benefit amount for my services and if that amount is less than our standard rate, we will adjust our fees to correspond to the “allowable” amount and you will be obligated to pay only the designated co-pay (also called co-insurance) and any deductible that may apply.

It is your responsibility to promptly notify our office of any changes in insurance policy information or benefits; follow directions to request pre-authorizations if necessary; and respond promptly to inquiries from your insurance carrier or requests we make regarding confirming your policy information.

Insurance policies rarely cover the entire expense for mental health services. You will be expected to pay the estimated co-payments/co-insurance/cost share at the time of each session.  We will attempt to accurately estimate this amount; however, if there is a balance remaining, you will be billed for this difference. If there is a credit, you will be notified, your account credited, or a reimbursement will be issued to you. You are responsible to pay the deductible and the co-payments/co-insurance/cost share required by their insurance plan.

It is important for you to understand that your counseling fees should not be considered to have been paid simply because an insurance claim has been filed. You will continue to be billed for the entire amount while the insurance is being processed. We are willing to wait a reasonable length of time for the insurance carrier to reply. (Not to exceed 60 days from the date the claim is filed).  We cannot guarantee your insurance benefits or the amounts covered, and we are not responsible for the collection of such payments. In some cases insurance companies or other third-party payers may consider certain services as not reasonable or necessary or may determine that services are not covered. In the event that any/all insurance claims are denied for any reason, you agree to pay us for the total amount of any/all denied insurance claims within 60 days after notification of this. This amount may be adjusted by mutual agreement in accordance with our Sliding Fee Schedule that was in effect at the time the services were rendered. In such cases the Person Responsible for Payment of Account is responsible for payment of these services. Payments not received after 120 days are subject to collections. We reserve the right to access a 1% per month interest rate is charged for accounts over 60 days.

If you choose to utilize your insurance benefits and unless the Person Responsible for Payment of Account pays the entire balance each session, you agree and authorize that all insurance benefits will be assigned to us by your insurance company or third-party provider. If your insurance company reimburses you directly, then you agree to that any and all insurance reimbursements received by you for counseling/therapy services provided by us will immediately be endorsed and given to us as part payment for our services.

If you belong to a health maintenance organization (HMO) or have another kind of health insurance with managed care, decisions about what kind of care you need and how much of it you can receive will be reviewed by that plan. The plan has rules, limits, and procedures that you should be aware of, such as required referrals and number of sessions authorized in a given period of time. Please contact your insurance company or employer for this information so we can discuss this at our initial meeting and decide what is in your best interest.

Release of Information Authorization to Third Party

We will provide information about you to your insurance company only with your informed and written consent. We may send this information by mail or by fax. We will try our best to maintain the privacy of your records, but we ask you not to hold us responsible for accidents or for anything that happens as a result.

If you choose to use your insurance benefits then you agree and authorize us to disclose case records (diagnosis, case notes, psychological reports, testing results,  or other requested material) to the above listed third-party payer or insurance company for the purpose of receiving payment directly to us.

We had no role in deciding what your insurance covers. Your employer decided which, if any, services will be covered and how much you (and us) will be paid. You are responsible for checking your insurance coverage, deductibles, payment rates, co-payments, and so forth. Your insurance contract is between you and your company; it is not between us and the insurance company.