HOW DOES THIS WORK?

Starting therapy, whether you’re a beginner or it’s “old hat,” can be daunting. Don’t worry, we’ll be here to make things as easy as possible for you. Will it all be 100 comfy? Probably not. Part of the growth process usually involves some moments of awkwardness or even what we might perceive as discomfort. But what I can guarantee is an ethically run practice with a safe place to sort through and receive help for what you’re going through.

DO YOU TAKE INSURANCE?

The answer is…sort of! There are several ways you can utilize health-related funds or out-of-network benefits through your insurance provider to receive potential partial reimbursement for services:

• The first is utilizing your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for services. This is a great option for those who want to have more choice about which provider they see and not be limited by whether or not their insurance is accepted by that specific provider. These are also pre-tax funds that many can utilize to pay for therapy. It can be helpful to check with the organization or bank that supplies your HSA or FSA about whether mental health services are an accepted service. On some occasions, your HSA/FSA administrator may request a “Superbill”, or itemized receipt, that includes necessary information to approve the use of your funds. It is important to note, some HSA/FSA administrators may require a mental health diagnosis as part of the necessary information to understand the charges to your account. If needed, I will provide additional information on the super bill upon request.

• Another option is to utilize your out-of-network benefits. Lots of the individuals I talk with are not initially aware they may be able to receive coverage for some of their therapy with these benefits. This is a great option for those who value choice but also want to take advantage of their insurance benefits. This will require you to pay up front (out of pocket) for services. Then you will submit what is known as a “Superbill”, or itemized receipt, to your insurance provider who will then reimburse you for the agreed upon rate depending on your specific plan.

There are a couple of important things to be aware of when selecting this option:

• In order to utilize out-of-network benefits, you will be assigned a mental health diagnosis. Insurance companies require a diagnosis to provide reimbursement for services.

• You may have a deductible that must be met prior to receiving reimbursement for services. The out-of-network deductible may be comparable or very different than your in-network deductible so it is important to check with your carrier to see whether or not submitting requests for reimbursement will be worthwhile in your specific situation. Sometimes folx decide that going with a private pay option where no diagnosis is required to be provided to a third party is their most advantageous and “cleanest” option.

My most important recommendation is to contact your insurance provider as you are exploring these options and ask questions about the information described here. Each insurance company is a little bit different and will therefore require different information from their members.

If you call your insurer to discuss coverage, be prepared to ask the following questions:

• Do I have mental health or behavioral health out-of-network benefits for outpatient settings?

• What is my out-of-network deductible? Has it been met?

• Is approval required by my primary care physician?

• How many mental health sessions does my plan cover annually?

• How do I obtain reimbursement for an out-of-network mental health provider?

• Are telehealth sessions covered?

• If you need specific CPT codes, they can be provided upon request.

I will do my best to help you understand your options, make a decision that best serves your needs, and feels connected with your values and goals. If you have any questions about the information described here, please reach out to me and bring any questions to your free 15-minute consultation call!

My independent practice is not in-network with insurance carriers at this time (it is underway!). I see a limited number of clients who would like to use their in-network insurance benefits through Cabot Psychological Services, PLLC. Please contact me if you would like to check on availability for this option.