Navigating insurance can be so confusing

Read below for some help in determining which options works best for you.

If you are insured through BCBS, I will submit insurance claims on your behalf and any portion owed by you will be due at the time of your appointment.

If you are not insured with BCBS, we have a couple of options to consider…

1) Use Out of Network Benefits (OON), if you have them: Some insurance plans provide out of network benefits, which offers you coverage for you to see providers that are not in your insurance plan’s network. It is important to note that this option requires you to pay the full cost up front. After the session, I will send you a receipt or “super bill” which you will use for submitting a claim to your insurance, prompting them to pay part, if not all, of the service. OON benefits are often also subject to a deductible so it really is so important for you to get these specifics from your insurance plan

2) Pay with HSA/FSA: If that is the case, I can keep your Health Savings Account or Flexible Spending Account card on your client file and charge it as I would with a credit/debit card. Please note that I will collect your payment option and payment form prior to our intake appointment via the new client paperwork. Some Medical Flex Spending Accounts (FSA) and Health Savings Accounts (HSA) may allow for reimbursement for services- reach out to your health benefits contractor to learn more.

3) Consider Private Pay: There are benefits to private pay that folks dont have communicated to them. Not only does private pay (ie not using insurance) allow us flexibility in how often and for how long we are able to meet, it also means I am not required to provide a diagnosis, increasing your own privacy. You would not have a therapy file added to your health care record, optimizing the control you have over your own health information. Private pay also allows me to offer specialty services that are not always covered by insurance plans, including couples/family sessions. Some times the deductible we have under our insurance plans are so high, it is not likely we will meet it within the year. This may be another reason for why private pay would better suit your needs as opposed to your insurance plan.

Calling Insurance

Before knowing which payment option would work best for you, we have to know what we are working with coverage wise. To gather this information, you will need to call the number on the back of your insurance card and ask to speak to a representative about the details of your coverage.

To provide you some ease in this process, I put a little script below you can use when calling…

Hello, I am interested in pursuing individual psychotherapy services for my mental health and would like to know what my coverage is for outpatient psychotherapy services. Can you tell me what my deductible is as well as what my copay/coinsurance is? To date, how much of my deductible has been met? Will my coverage be the same depending on if I attend my appointments virtually or in person?  Are there any prior authorizations required for mental health coverage?  

For Out of Network Questions

Do I have out of network benefits (OON) and if so, what is my OON deductible? Do I have to have a referral from an in network provider in order to be able to see an OON provider? Am I able to use these benefits for telehealth? If I were to use OON benefits, what percentage of the service can I expect to be covered by insurance? Where should I be submitting claim forms and how long will it take to expect reimbursement?

Once you have collected this information, you will have a better understanding of your coverage which allows you to make a more informed decision about your care. You may find that your deductible is too high or that your general mental health coverage is insufficient for your needs. This is another situation in which private pay may make more sense.

Deductibles

Most, but not all, insurance plans have a fixed deductible that you will need to reach each insurance year (12 months from the start of your insurance) BEFORE insurance will cover services. This deductible could be $100 or several thousand dollars. If you have a deductible, insurance will process your claim and your responsibility will be the full rate for the service until that deductible is met.

For example, if your deductible is $100 then we will meet it (and then some) after the first intake session. After that, you will pay the co pay or coinsurance requried from you and insurance takes on the rest. If you deductible is $500, an intake session and two on going sessions would need to be paid in and then your deductible would be met.

COPAY & COINSURANCE

Usually after you exhaust your deductible in each insurance year, you have just a copay or a coinsurance to pay. A copay is a fixed amount you will pay each session, like $20 or $40. Insurance will cover the rest of our contracted rate. A coinsurance is a percentage you pay for each session, like 20% or 30% of the contracted rate. For example, if you have a 30% coinsurance, you would be responsible for paying $45 dollars of the total $150 session fee ($150 x .30%= 45.00) Insurance will cover the rest of our contracted rate.

Breaking down Insurance Terms

FAQs

  • I am a private pay provider that also is credentialed with Blue Cross Blue Shield. There are plenty of folks who have insurance that choose to pay private pay rates due to the freedom and flexibility of this option.

  • Insurance companies are inherently predatory for both clients and clinicians. Not only is it often time limited and confusing to navigate benefits but it is dependent on a potential stigmatizing or pathologizing diagnosis. In providing a diagnosis employers, other providers, military, etc.… may have access to this information. Using insurance often means your provider can request session notes and other related documents at any time. Choosing to not use insurance for sessions opens up flexibility on the frequency and length of our sessions. It also protects your privacy and safety.

  • Some insurance plans have Out of Network benefits which allows a subscriber to see providers that are not in their insurance plan’s network. It is important to note that this option requires you to pay the full cost up front.

    After the session, I will send you a receipt or “super bill” which you will use for submitting a claim to your insurance, prompting them to pay part, if not all, of the service. OON benefits are often also subject to a deductible so it really is so important for you to get these specifics from your insurance plan

  • To gather this information, you will need to call the number on the back of your insurance card and ask to speak to a representative about the details of your coverage.

    Please see above this section for a script you can use when calling insurance!