Financing Therapy
Access to services is paramount in order that you or your loved one receive needed care. Payment for therapy services happens in a number of different ways. If you have received a referral for services, then fees will be billed to insurance (copays may apply). I some cases, insurance coverage may be obtained without a referral via reimbursement for covered out-of-network services. Finally, there’s the option to pay fees out-of-pocket. Each of these three options is described below.
1) Insurance Referrals
My practice is paneled directly with Aetna, Elevant, Blue Shield and Signa insurance providers. I also accept clients from Carelon Behavioral Health (CBH). CBH administers the Medi-cal program in the state of California through Partnership Health Plan. They also administer several employer’s EAP programs. If you have a referral from CBH then fees (less copays) will be billed to them by me after a simple verification of eligibility. Payment of copays becomes your only responsibility.
In addition, although I am not directly paneled with Kaiser Permanente, they have an established relationship with CBH for “overflow” referrals to out-of-network providers. If you have Kaiser Health Insurance, you may contact them to pursue eligibility for an out-of-network referral to CBH. If Kaiser approves this referral, then session fees (less copays) would again be billed to CBH by me.
2) Insurance Out-of-network reimbursement
Many insurance companies offer benefit coverage for mental health services out-of-network. You must contact your insurance company for information and eligibility. If eligible, therapy payments are made by you to me in full. Subsequently, I issue to you a “Superbill” which may be submitted to your insurance company for reimbursement.
3) Private Pay
Fees may be paid out-of-pocket. In this case you accept full responsibility for payment. This includes payment of late cancel or missed sessions. My session rates are $140 per 50 min sessions. Family and couples session commonly run for a longer time (example: $220 for 80 min session).
For private pay, the Federal “No Surprises Act” (H.R. 133) requires that you be provided with a good faith estimate of service fees. As an example, if we assume that indicated treatment is for the provision of weekly 50-minute psychotherapy sessions over the next 12 months. Taking into consideration vacations, holidays, emergencies and sick time an estimated $6300 (= $140 x 45) total charges are incurred for a total of 45 sessions. Estimates are revised if changes occur in your treatment plan due to adjustments in session frequency or gaps in treatment.