Fees + Insurance
All other commercial plans generally cover mental health services but our clinic would be considered an out-of-network provider. This means you would receive a superbill and receipt that you can submit to your insurance company for reimbursement of services. You may provide your insurance company with this bill and be reimbursed 50-100% depending on your plan. Please call your insurance company and find out whether they cover out-of-network services. Medicaid and/or Medicare, most HMO and EPO plans do not reimburse out of network.
Prior to your appointment, you can inquire with your insurance company to find out about your out-of-network coverage, co-pay obligations, deductibles, or any pre-authorizations that may be needed. You can find out your out of network benefits by calling the number on the back of your insurance card. Please note that insurances usually do not reimburse for fees outside of appointment times which includes charges for no-show, late or cancellation fees, such as paperwork fees.
Ask about whether or not there are "out-of-network" benefits and if so, how much is reimbursed.
Ask about any deductibles that must be met before these benefits are active, make sure to ask if the insurance has two sperate deductibles, one for "in network", and one for "out of network".
Ask if a referral or prior authorization is required and if there are limits on the number of therapy visits in a given time period.
Ask how to submit claims for reimbursement (typically this is done online or by mail after the provider gives the patient a receipt that includes all relevant diagnostic and service codes). You can consider using an app such as Better Claims or Reimbursify or submitting directly through the insurance company by calling them and asking what are the steps. We do not do courtesy billing or balancing billing.
Codes commonly used:
90792 – Initial evaluation
99212 – Medication check, straightforward
99213 – Medication check, low complexity
99214 – Medication check, medium complexity
90833 – plus psychotherapy, 16-37 mins
90836 – plus psychotherapy, 38-52 mins
90838 – plus psychotherapy, >52 mins
What's the benefit if you chose a out of network treatment team:
Privacy – we don’t have to send your information to insurance. (Do know that the superbill requires a diagnosis and keep in mind that the insurance may request your medical records from us. )
Flexibility – no limits on services you can receive or the number of sessions you can have.
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 bill for medical items and services. You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost, which can only be established after your initial assessment. You will be provided details on the cost for just the initial assessment before the session. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.