Insurance & Fees

Insurance

You pay for insurance and therefore you want to take advantage of the benefits afforded to you. Please review this section carefully. While we endeavor to provide up-to-date information here, you are solely responsible for understanding your  benefits and the limits thereof.

Disclosure.

Insurance requires that the care provided is medically necessary based on symptom severity meeting criteria for a psychiatric diagnosis. In other words, when you use your insurance, you must be given a psychiatric diagnosis. There is no exception. If you’re symptoms do not meet diagnostic criteria, you will not be eligible to use your insurance.

You might think, “Well, my previous therapist/psychiatric nurse practitioner didn’t give me a diagnosis, and I used insurance then.” You most definitely received a diagnosis. You simply may have not been told what diagnosis was used.

We are happy to bill your insurance for services provided for the treatment of specified psychiatric conditions.

 

Marriage or Couples Counsling.

Insurance is not accepted for marriage or couples counseling where the goal is to improve communication, intimacy, to address infidelity, etc.

Insurance requires that treatment focus on alleviating psychiatric symptoms of an individual. 

Couples Counseling and Marriage Therapy focuses on improving the quality of the relationship. The relationship is the client, not any specific individual.

Insurance companies are solely in the business of providing coverage for medical conditions that require treatment based on the severity of symptoms. Insurance companies are not in the business of helping you with your relationship.

You might be thinking, “My prior marriage therapist billed my insurance.”

While this might have been the case, this implied that you had the problem (i.e., psychiatric condition). 

Our experience is that the problem is in the relationship and not between any individual person’s ears. You have heard of the old saying, “It takes two to tango.” When either person has never tangoed, the dance can look like a mess. The mess, however, isn’t evidence that either individual is impaired. The mess is normal result from this particular context (i.e., two people who don’t now how to tango).

Ultimately, we are advocates for your relationship. Insurance requires that the therapist 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.

In-Network Insurance

Please ensure that your individual provider is in-network with your specific insurance plan. You can find this information from your insurance company’s website. Not all providers are In-Network with the following plans

AETNA

BLUE CROSS/BLUE SHIELD
(except for Blue Local)

CBHA

CIGNA

MEDCOST

UNITED/OPTUM

 

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? 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?
  • Does my policy cover an Out of Network, Licensed Clinical Mental Health Counselor, Licensed Clinical Social Worker Associated, or Marriage and Family Therapist?
  • 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) or, if applicable, Couples Counseling (if so, which CPT code is required). 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: 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.) 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. They may try to withhold this information from you and can legally do so. Ask to speak to a supervisor and convey to them that you cannot plan your medical expense budget without this number.

Fees

Private pay fees depend on the provider and specific services. Below are current rates. Rates are subject to change.

Psychotherapists

DR. Tom Murray, LMFT, LCMHCS

Initial session: Couples (90 minutes): $240.00.
Initial session: Individuals (50 minutes): $175.00.

Follow-up appointments

  • 45-50 minutes: $150.00
  • 53-60 minutes: $170.00
  • 90 minutes: $240.00

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.

Extended Service fee (When sessions exceed permissible length of time)

  • 40-45-minute $140
  • 15-minute increments: $40

Analise Anderson, LCSW

Initial session: Couples (90 minutes): $190.00.
Initial session: Individuals (50 minutes): $125.00.

Follow-up appointments

  • 45-50 minutes: $100.00
  • 53-60 minutes: $120.00
  • 90 minutes: $190.00

Late Cancellation with 24-hour advanced notice

  • 45-60 minutes: $75.00
  • 90-minute sessions: $100.00

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

ADvance psychiatric Nursing

Laurie Arena, PMHNP, mSW &
Nancy Plothero, PMHNP

Intakes/Initial Appointment (90 minutes): $280

Follow-up Appointments (20+ minutes): $140

Blended therapy plus Medication Management extended sessions (50 minutes): $200

*Sliding scale available on a limited bases, Income-based

*Fees/charges submitted to insurance vary depending on the content of visit.

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.

© A Path To Wellness 2021

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