Notes on Clinical Services

I am not in-network for most health insurance plans, which allows me to dedicate more time to face-to-face client care and maintain a sustainable practice. By offering private pay services, I can provide highly personalized, customizable, and private care that is not directed or limited by insurance company policies.

I maintain a contract with Traditional Medicare to ensure therapy services are accessible to clients who might otherwise be unable to afford mental health care. This contract requires adherence to Medicare regulations for those services. Additionally, I offer a limited number of reduced-rate slots for private pay clients. Balancing private pay, out-of-network care, and reduced-rate options helps me serve a diverse range of clients.

For clients seeking out-of-network reimbursement, knowing that your insurance company may have requirements, such as session lengths and session frequencies, and require a diagnosis is important. To help with this process, I encourage you to confirm your out-of-network benefits by asking your insurance company the following questions:

• What is my out-of-network deductible?

• What is my share of cost for services (copay or coinsurance)?

• What is the maximum allowable rate for the services I’m seeking?

• Is there a limit for the number of sessions or session frequency?

Feel free to ask me for the billing codes I use for the services you need.

Out-of-network plans vary: some offer excellent coverage with low deductibles, copays, and high maximum allowable rates, while others may have limited coverage offset by other factors like low premiums. Choosing out-of-network care often allows you to select a provider who fits your needs, has availability, or offers specialties not accessible in-network.

Private pay clients and those seeking out-of-network reimbursement will receive a Good Faith Estimate (GFE) as the No Surprises Act requires. This estimate will outline projected costs for the calendar year based on your chosen session frequency, with adjustments for significant changes. Payment is due at the time of service, eliminating surprise billing. Costs are straightforward and based on the type and frequency of services scheduled.

For insurance reimbursement for out-of-network care, I provide a monthly superbill that includes all necessary details, such as services received, payments made, and required information for your insurance company to process reimbursement under your plan.