We are an out-of-network provider for health insurance. Our practice does not take insurance directly, but many of our patients get reimbursed for their sessions. If you are a member of a financially oppressed group and in need of a sliding scale or other forms of financial equity, please speak to your therapist about our different options.
If you have out-of-network benefits you may get reimbursed for your sessions.
How it works: Most commercial insurance companies pay 60%-90% back. All state insurance companies (Obamacare, Medicaid, insurance from the exchange, etc.) do not pay anything back, so you would not have any out-of-network benefits. If you have out-of-network benefits, at the end of the month you will get a “superbill” that has everything you need to get reimbursed from your health insurance. If you have other questions, please speak to your therapist, or contact our administrative team at firstname.lastname@example.org
Here is an example: Your session fee is $125, and your deductible is $1,000 for out-of-network benefits. Your reimbursement rate is 40%. Your first 8 sessions will go towards your deductible ($125 x 8 = $1,000). For the rest of the sessions, you will pay $125 upfront (upfront? paying before the sessions?) and your health insurance will send you $75 per session (40% of $125 = $50), which translates into paying $50 out of pocket per session ($125 – $75 = $50). You are responsible for 40%, and your health insurance is responsible for 60%.
If your insurance has a $1,000 deductible for out-of-network benefits (separate from your in-network-benefits deductible), and your insurance company says that you have 30% co-insurance, that will mean that you get 70% back from your session fee after your deductible is met.
Please call the number on the back of your card. Alternately, this information should be on your SPD (Summary Plan Document), or on your health insurance website when you log in. We highly recommend that you speak to a human to get this information. Here is a list of questions you can ask your insurance company:
- Do I have out-of-network benefits for mental health?
- Is there a deductible? How much is it currently? Is there a family and individual deductible? And if so, what is the current balance for each?
- Is the deductible separate from the regular medical deductible, and when did this deductible start (January or another time)?
- Is there a limit on sessions per year?
- Is there a co-insurance? And if so, what percentage is the reimbursement? When does this co-insurance start? Does it start before or after the out-of-pocket max is reached?
- How do I submit claims? (Forms and addresses)
- For CPT code 90834, what is your reimbursement rate for New York City?