Fees, Payment and Insurance Filing
Choosing to engage in psychotherapy involves a commitment of time and money in your personal growth. Your financial commitment is similar in importance to other aspects of your life that you examine throughout counseling. We can discuss how you incorporate the costs of counseling in your budget.
Regardless of how you pay for counseling, I will provide you with a financial statement of your account at the end of each month for your records; this statement may be helpful as you incorporate counseling into your monthly bills, determine your income tax deductions, or submit to employer-sponsored medical deferment/reimbursement programs.
Self-Pay
When you pay for your counseling in its entirety – and do not rely on insurance or other 3rd party payors – you maintain the most control over your privacy. That is, in most situations your counseling can be completely confidential in that you must give me permission to consult with another provider, institution, agency or individual in your life. We will discuss the few exceptions to complete confidentiality in this situation.
If you need to negotiate an adjusted fee in this self-pay situation, I will ask that you bring Xerox copies of your most recent annual income tax filing as well as your most recent pay stub (or quarterly filing if you are self-employed). If you are primarily supported by parents or a partner, I will request that you bring this information for them as well as for yourself to negotiate an adjusted fee with me. We will consider your monthly bills in light of your income. Based on this information, you and I can discuss a reasonably adjusted fee that fits into your budget but also covers my services and time.
In addition, I will ask you to sign an agreement regarding the adjusted fees as well as your decision to pay for your treatment without involvement of insurance or other financial payor.
Using Insurance
Many individuals pay for health insurance that includes coverage for psychotherapy. If you wish to submit psychotherapy claims to your insurer you should complete some basic research before you get started. This research is especially important in 2011 due to changes in federal law that cover parity for medical/psycholgical services among other now legally mandated coverages.
Your insurance coverage typically will cover a portion of each appointment, may require that you meet an annual deductible (that typically will be satisfied by the first counseling or physical health claims submitted in a given calendar year), and may require that preauthorization is required at some point in your counseling. It is important to recognize that your insurance policy may have coverage limits that do not coincide with the frequency or duration of treatment that is advisable for you. In this case, you will accept financial responsibility for all services not covered by your insurance policy.
If your insurer requires the completion of a preauthorization form showing medical necessity before counseling appointments will be reimbursed, you and I will complete the form together. In addition, I will discuss any insurer or other outside information requests with you before I release information about you.
Blue Cross / Blue Shield of Illinois
Currently, I am an in-network panel provider for BCBS/ILLINOIS-PPO/POS policies and will accept the contract provisions of any BCBS-PPO or Indemnity policy that provides adequate reimbursement within a 30 day period following claim submission. You probably will be responsible to pay a coinsurance or copayment at each session or to pay me for sessions applied toward satisfying your annual deductible, but I will not bill you for the insurance adjustment that BCBSIL calculates. I will submit claims on your behalf to BCBS/IL and accept assignment from BCBS/IL. BCBS policies based in other US states also cover my services and will process claims through BCBS/IL. Please note, however, that I am not a BCBS-HMO provider and will not be covered under any BCBS-HMO policies for any psychotherapeutic services.
Other Insurers
If you are insured by a PPO or Indemnity policy underwritten by another insurer — e.g. CIGNA, AETNA, UNITED HEALTH CARE, UNITED BEHAVIORAL HEALTH, GUARDIAN, WPS, other insurers — your work with me should be reimbursed if you have coverage for psychotherapy. I will ask that you pay me for each appointment at the time you meet with me, and I will give you a completed insurance claim at month end. In this situation, you pay the entire appointment fee but you are reimbursed directly by your insurer when you mail in the completed HCFA claim form. Should your insurer require forms to preauthorize or evaluate your treatment, you and I can review the information before I release it to your insurer. I will ask you to sign an agreement that lists how you will pay for your treatment, what insurance plan you will utilize, etc.
I am neither a MEDICARE, a MEDICAID nor an HMO provider with any insurer at present. These insurers will not reimburse your treatment with me.
Researching Your Insurance Benefits
Regardless of what insurance company you are covered by, please contact your insurer at the telephone number on the back of your card and ask the following questions before meeting with me:
- Does my insurance policy include benefits for counseling? If yes, how many sessions are allowed per week/per calendar year before an out-patient preauthorization form must be completed? Are there annual limits on the dollar amount or number of appointments for which I can receive coverage?
- What percentage — or dollar amount — of each psychotherapy session (with CPT code 90801, 90806, or 90808) are paid by my insurance policy?
- What is my annual deductible? How much of my annual deductible has been satisfied at this time?
- Is there anything that may result in claim denial, eg. is there a different reimbursement rate or number of sessions provided to me for in-network vs out-of-network providers, does my policy cover biological/nonbiological diagnoses at different rates, or are some diagnoses not reimbursed by my policy?