SELF PAY OR INSURANCE? WHAT IS RIGHT FOR ME?

There are few issues you may consider when deciding whether to pay for therapy yourself or to use insurance:

  • Using insurance requires that some of your health information is shared for billing and authorization purposes which results in less confidentiality for you

  • Insurance company controls how long you can be in therapy and how many sessions you can have.

  • A mental health diagnosis that meets medical necessity is required for insurance payment. If you do not have a diagnosable condition, the insurance company will deny the claim and you will be responsible for payment. Therapy for issues such as stress management, self-esteem and personal growth are worthy therapy concerns but are not reimbursable by insurance.

Fees

  • $150 for an Initial assessment session (CPT 90791)

  • $130 for a 45 minute session (CPT 90834)

  • $150 for a 60 minute session (CPT 90837)

    Fees are due at the start of session.

If you would like to learn about market rates for therapy in your area, you can look up CPT codes on Fair Health Consumer

accepted payments

  • cash

  • credit/debit card

  • Some HSAs

  • Payments are processed with Ivy Pay

Self Pay

If greater control over the privacy of your health information and greater control over your healthcare are important to you, you may prefer to pay for your counseling yourself instead of using insurance.

INSURANCE

Out Of Network:

  • Anthem

  • Cigna

  • Other Insurances

If you have a PPO plan, you may have Out Of Network (OON) benefits. This means you will pay for your service up front and wait to be reimbursed by your insurance company. I can provide you with a receipt called a Superbill that you can submit for reimbursement. The amount you are reimbursed will depend on your plan.

Questions to ask your insurance company:

  • Do I have Out Of Network benefits?

  • How much is my deductible and how much has been met to date?

  • How much will I be reimbursed for psychotherapy? (CPT codes 90791, 90837, 90834)

In Network:

  • Aetna

  • Blue Shield

  • Health Net

  • Magellan

  • MHN

  • Optum/United Healthcare/UBH

  • Tricare West

Questions to ask your insurance company:

  • How much is my copay?

  • Do I have to meet a deductible and how much has been met to date?

  • Do I need an authorization?

*Copays, cost-shares and deductibles, if applicable, are due at time of service.

Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.