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 with Aetna, Anthem Blue Cross, Blue Shield, Cigna, Magellan, Oxford, Quest, and United Health 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 referrals from Kaiser Permanente and 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. Copays become your only payment responsibility.
Although I am not directly paneled with Kaiser Permanente, they have an established relationship with CBH for referrals to out-of-network providers. If you have Kaiser Health Insurance, you may contact your PCP to pursue eligibility for an “out-of-network authorization” to CBH for mental health services. Upon approval of this authorization by Kaiser’s Psychiatry Dept, 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.