Insurance and Fees
Invest in yourself and your relationship
Our policies, insurance, fees, and providers.
Our prices and policies
As someone who invests in insurance coverage, it’s crucial to capitalize on the perks it provides. Therefore, it’s vital that you thoroughly review this section that outlines your insurance benefits. Although we strive to keep this information current, it’s ultimately your responsibility to comprehend the extent of your insurance coverage and its restrictions.
Additionally, insurance plays a significant role in protecting you from unexpected financial burdens. So, having a firm grasp on your insurance benefits is a good idea. Moreover, please don’t overlook the importance of understanding your insurance benefits, as they can be the difference between financial stability and chaos. Lastly, remember that insurance coverage can vary greatly, so be sure to read the fine print of your insurance policy to maximize its benefits.
Disclosures
Understanding Insurance Coverage for Psychiatric Treatment
Insurance Requires a Psychiatric Diagnosis based on Symptom Severity. To use insurance for psychiatric treatment, a diagnosis based on symptom severity meeting specific criteria is required without exception. Even if you have seen a therapist or psychiatric nurse practitioner who did not give you a diagnosis, you may have received one without being informed.
Previous Diagnosis and Usage of Insurance
If you have previously used your insurance for psychiatric treatment, you likely received a diagnosis. It is important to keep this in mind when considering the use of insurance for future treatment.
Insurance Coverage for Specific Psychiatric Conditions
While we are happy to submit claims to your insurance for services provided for specified psychiatric conditions, it is important to note that some diagnoses may not be covered by certain insurance policies, such as sexual health disorders. Just because your symptoms meet the criteria for a psychiatric diagnosis, there is no guarantee that your insurance will cover the cost.
Coverage Limitations and Personal Responsibility
Ultimately, any charges not covered by insurance will be your responsibility. Therefore, it is important to understand the limitations of your insurance coverage and be prepared to cover any costs that may not be covered..
Marriage and Couples Counseling
Insurance Coverage for Psychiatric Symptoms vs. Relationship Counseling
While insurance may cover treatment for psychiatric symptoms, it is not accepted for marriage or couples counseling aimed at improving communication, addressing infidelity, and decreasing relationship distress.
The Focus of Couples Counseling and Marriage Therapy
Couples counseling and marriage therapy focus on improving the quality of the relationship, with the “client” being the relationship itself, not any specific individual. Insurance companies, on the other hand, provide coverage for medical conditions that require treatment based on the severity of symptoms, but are not in the business of helping with relationships.
Implications of Billing Insurance for Marriage Therapy
Although you may have had a prior marriage therapist bill your insurance, this implies that the problem is a psychiatric condition and that treatment aims to alleviate those symptoms. However, our experience shows that the problem is in the relationship itself and not an individual’s psychiatric diagnosis.
The Normalcy of Relationship Struggles
It takes two to tango, and when either person has never tangoed, the dance can look like a mess. However, the mess isn’t evidence of any impairment, but rather a normal result of the particular context of two people who don’t know how to tango.
Advocating for Your Relationship: Why We Don't Bill Insurance
As advocates for your relationship, we do not bill insurance, as it requires the therapist to be the advocate for the person with the diagnosis. Therefore, when a provider bills insurance, the treatment agenda must be set by the patient with the diagnosis, rather than the relationship itself.
In-Network Insurance
Not all providers are In-Network with all plans.
Please ensure that your individual provider is in-network with your specific insurance plan. You can find this information on your insurance company’s website.
We are happy to verify your benefits and bill your insurance as a courtesy. Nevertheless, you are solely responsible for knowing your benefits and the limits of your coverage.
Out-of-Network Insurance
Have another insurance not listed above, or is your preferred provider not associated with your insurance? You might be eligible to use out-of-network benefits. We are happy to submit claims on your behalf, which will contribute to your deductible or result in reimbursement from your provider.
If you would like to inquire about Out-of-Network Benefits, we provide the following questions to ask your insurance company representative:
- What are the representative’s name and extension number?
- Are services rendered by my preferred provider covered within my Out-of-Network benefits?
- My therapist is willing to provide a statement (aka, Superbill) of Session Dates Attended, the CPT code, and the diagnosis. Is this acceptable to the insurance company?
- Does my policy cover Individual Psychotherapy (CPT code 90834). Please note, most insurances do NOT cover Couples or Marriage Counseling.
- What mental health diagnoses are NOT reimbursable?
- How many sessions are covered per year?
- What is the lifetime maximum for mental health benefits?
- What is my Out-of-Network deductible?
- What is the allowed amount of the fee?
- What percent of the allowed amount will be reimbursed?
- How do I file a claim?
nOTE: Understanding Insurance Reimbursement for Therapy Sessions
When it comes to paying for therapy sessions, it’s important to understand how insurance reimbursement works. Here are some key points to keep in mind:
Percentage Reimbursement
Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid ($160 of the total fee of $200).
Allowed Amount Reimbursement
Other companies will substitute the $200 fee for what they deem appropriate, regardless of what you paid. For example, your company might say that they will reimburse you 80% of the “allowed amount of the fee.” You paid $200 for an individual session, but your insurance company only allows $100; therefore you will be reimbursed 80% of the $100, or $80.
Asking for Information
It’s important to note that insurance companies may try to withhold this information from you, and can legally do so. However, you can ask to speak to a supervisor and convey to them that you cannot plan your medical expense budget without this number. By understanding how insurance reimbursement works, you can make informed decisions about your therapy sessions and budget accordingly.
Fees
Private pay fees depend on the provider and specific services. Below are current rates. Rates are subject to change.
Psychotherapists
Analise Anderson, LCSW
Prices Effective 10.01.23
Initial session: Couples (90 minutes): $210.00.
Initial session: Individuals (50 minutes): $140.00.
Follow-up appointments
45-50 minutes: $110.00
53-60 minutes: $135.00
90 minutes: $190.00
Late Cancellation with 24-hour advanced notice
45-60 minutes: $100.00
90-minute sessions: $140.00
No show fee
Fee is equal to the amount for the missed session.
Extended Service fee (When sessions exceed permissible length of time)
40-45-minute $100
15-minute increments: $20
In-Network Provider
- BCBS (Most plans)
- United/Optum
- MEDCOST
- CBHA
- AETNA
- CIGNA
- Medicare
HANNAH SMITH, lcmhca
Prices Effective 10.01.23
Initial session: Couples (90 minutes): $210.00.
Initial session: Individuals (50 minutes): $140.00.
Follow-up appointments
45-50 minutes: $110.00
53-60 minutes: $135.00
90 minutes: $190.00
Late Cancellation with 24-hour advanced notice
45-60 minutes: $100.00
90-minute sessions: $140.00
No show fee
Fee is equal to the amount for the missed session.
Extended Service fee (When sessions exceed permissible length of time)
40-45-minute $100
15-minute increments: $20
In-Network Provider
- BCBS (Most plans)
- AETNA
Randy Garcia, LCMHCA
Prices Effective 10.01.23
Initial session: Couples (90 minutes): $210.00.
Initial session: Individuals (50 minutes): $140.00.
Follow-up appointments
45-50 minutes: $110.00
53-60 minutes: $135.00
90 minutes: $190.00
Late Cancellation with 24-hour advanced notice
45-60 minutes: $100.00
90-minute sessions: $140.00
No show fee
Fee is equal to the amount for the missed session.
Extended Service fee (When sessions exceed permissible length of time)
40-45-minute $100
15-minute increments: $20
In-Network Provider
- BCBS (Most plans)
- AETNA
- MEDCOST
DR. Tom Murray, LMFT, LCMHCS
SEX THERAPY AND COUPLES COUNSELING
Initial Appointment
55 minutes $215
90 minutes $340
Follow-up Appointments
45-50 minutes: $170
53-60 minutes: $210.00
75 minutes: $285
90 minutes: $340.00
DISCERNMENT COUNSELING for Couples on the Brink
First Session (2 hours) – $400
Follow-up Sessions #2-5 (90 minutes) – $340
Late Cancellation with 24-hour advanced notice
45-60 minutes: $100.00
90-minute sessions: $150.00
No show fee
Fee is equal to the amount for the missed session.
Out-of-Network Provider
Cancellation Policy
Cancellation Policy: We will charge a late cancellation fee if you do not cancel within 48 hours’ notice or no show fee, as stated in our policies. If forms are not completed within 48-hours of the appointment, we will cancel the appointment.
Paperwork: Please fill out and sign all the client intake forms, including the payment information document, before your first appointment with us. We require all clients to leave a credit card, debit card on file at the time of scheduling. We will charge a late cancellation fee if you do not cancel within 48 hours’ notice or no show fee, as stated in our policies. If you do not receive an email invitation to complete the forms, please contact the office as soon as possible. If forms are not completed within 48-hours of the appointment, we will cancel the appointment.
