THERAPY INSURANCE QUESTIONS
In-Network vs. Out-of-Network Provider: An in-network therapist has a direct contract with your insurance carrier to provide services at a negotiated rate. An out-of-network provider does not have a contract, but your plan may still cover a significant portion of the cost through out-of-network benefits.
Deductibles and Co-pays: Your deductible is the annual amount you must pay out-of-pocket before your insurance coverage kicks in. Once met, you may only be responsible for a small copay (a fixed dollar amount per session) or coinsurance (a percentage of the session cost).
Superbills and Reimbursement: If you see an out-of-network therapist, you typically pay for the session upfront. Your therapist can then provide you with a superbill—a detailed statement utilizing standard clinical billing codes (such as CPT codes)—which you submit directly to your insurance company to request direct reimbursement
Navigating Your Mental Health Insurance Benefits
Understanding how to utilize health insurance for therapy can be confusing. To help you maximize your coverage and avoid unexpected out-of-pocket expenses, it helps to understand how insurance companies structure behavioral health benefits:
Kevin’s Insurance Participation for Therapy:
Kevin participates as an in-network provider with many insurance plans including Medicare, Horizon BCBS, United, as well as others.
Beth’s Insurance Participation for Therapy:
Beth participates with Horizon BCBS (Traditional & PPO plans only), Aetna insurance & is an out-of-network provider for many of her counseling clients. If you use out-of-network benefits, this means, you will be provided with an itemized receipt so you may submit for any reimbursement from your insurance directly should you choose.
If you’re using insurance, we always recommend:
Call your specific plan using the member service’s number on the back of your insurance card and ask them if we are considered in-network for your particular plan prior to reaching out for therapy as there are a vast number of plans currently on the market. Your plan is a contract between you and your insurance company.
For clients not wishing to, or it not being a concern, to utilize insurance, we will provide you with a receipt at the end of each month should you wish to submit for any possible reimbursement.
Clients who are uninsured or are self-pay (or not using their insurance benefits) will be provided a Good Faith Estimate prior to the start of care. You will be asked to consent to not using your insurance (if you have it and choose not to use it), as part of our Treatment Consent process.
For more information about Good Faith Estimates & your rights, please click here.
Reviewed by Beth Kane, LCSW on 10/12/206