What fees should I expect?
Licensed Therapists charge a range of fees. Most are between $100-$350 per 45 or 50 minute session (lengths vary by therapist, and rates vary by location). These prices are before any insurance coverage. Some clinicians offer a sliding scale or pro bono services. Check with each clinician individually.
Is every therapist and counselor able to go through my insurance?
No. The main difference here is state licensing. Licensed therapists and counselors receive a license from their state which is bestowed after completing a master's or doctoral degree and a certain number of supervised face-to-face client hours. One benefit of having a license is the ability to offer mental health diagnoses, which is required for insurance claims (for both in-network and out-of-network).
Pastoral Counselors are not always licensed, but some are. Check with any pastoral counselor individually. Lay counselors are typically not licensed by the state, but are instead trained or endorsed by a church or Christian ministry.
How do I handle my insurance?
Begin by checking on your coverage in the written materials from you insurance company (often available on their website and after you’ve logged in to check on your personal policy). Many insurance plans note in one or two line items in your personal policy what your mental health coverage is. It will be a combination of percentage, deductible, or co-pay.
Call their customer service line to ask more questions in order to understand what your personal policy plan is.
Allowable Amounts
For out-of-network clinicians, the insurance company may have an “allowable amount,” which is the charge rate the insurance company will use to determine the amount they will reimburse you with.
Let's say the insurance company pays 70% and you are responsible for paying the other 30%, and the session fee is $150.
But, there is also a $90 "allowable amount" by the insurance company. This means that no matter what amount the therapist charges, the insurance company will only cover the $90 portion of the bill.
You are responsible for paying 30% of that $90 and the insurance company pays 70%. This means they will reimburse you 70% of $90 ($63), and you will be responsible for paying the remainder ($87).
In sum, you will pay $87 out of pocket total
Check the allowable amounts with your insurance company. You could have thought that they'd cover 70% of the $150 fee ($105) and you'd only pay 30% ($45). But with the allowable amount our portion is over $40 more.
When you contact a therapist ask him or her if they are affiliated with any insurance networks. If they do work with your insurance company, you may want to contact your health insurance company after speaking with a clinician in order to confirm that the specific clinician is included in your personal plan.
Even if a therapist is not affiliated with any insurance network, your person insurance policy will have details about how much out-of-network coverage you are eligible for. This is often calculated by a deductible, allowable amount, percentage of coverage, or co-pay. You can also call your company directly to ask more precisely about your individual plan.
For in-network clinicians:
You will pay your portion directly to the clinician and they will submit the paperwork to the insurance company directly (as they will receive additional payment from the company). The amount you pay the clinician may change over time depending on your policy (if deductibles or other requirements are met, or a new year begins). Often you pay a co-pay (which usually ranges from $20-$75) or a percentage.
For out-of-network clinicians:
You will pay the full amount directly to the clinician and they will give you a receipt. Some clinicians provide receipts after every therapy session and others provide a receipt in monthly batches, sometimes called a "superbill."
Each receipt will include the following information:
Name of the provider
EIN: Tax ID number
NPI: National Provider Number; any clinician who is eligible for you to be reimbursed will have one of these numbers
Address of where you meet with them
ICD-10 Diagnosis Code: this often begins with a letter (F for mental and behavioral health) followed by numbers, with a period. For example: F32.0; F41.1; F43.20; etc.
CPT or Service Code: this is a 5 digit number that is a description of the service. For example: 90834: Individual Psychotherapy; 90846: Family Psychotherapy without Patient; 90847: Family Psychotherapy.
Dates of service
Amount paid
You will submit your receipt to your insurance company (either with a form online or through the mail by including the receipt and filling out the insurance company’s form).
The insurance company will process your claim and apply the amount to your deductible. Depending on your plan, they will also send you a reimbursement, often by check.
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