For a list of accepted therapy insurance plans or how to use your Out of Network benefits, please review the information below.
Insurance Factors to Consider:
- Insurance REQUIRES a psychiatric diagnosis. Yes, that’s right. To use your insurance, your insurance requires that the service be “medically necessary,” which means that your symptoms must meet criteria for a psychiatric diagnosis. Those seeking couples counseling and who want to use insurance, at least one partner must have a psychiatric disorder AND the purpose of couples counseling MUST be to treat the symptoms of that disorder.
- Insurance companies dictate length of sessions. If you use insurance, initial session is 45-60 minutes, depending on your insurance contract. United Behavioral Health and Cigna allow for only 45-minute sessions. If you want a 60 minute session, please indicate this at time of the appointment; a nominal, extended service charge paid out of pocket can be added to your bill. This service charge is not reimbursable by insurance but can be paid out of an Health Savings Account or Flexible Spending Account.
- For couples whose insurance allows for couples therapy: Dr. Murray requires two 45 minute units (totaling 90 minutes). The first unit will be charged to insurance, the second unit will be out of pocket. Discuss this with Dr. Murray if you have questions.
- Initial session (90 minutes): $240.00.
- Initial session (60 minutes): $175.00.
- Follow up appointments (45-50 minutes): $140.00
- Follow up appointments (55-60 minutes): $150.00
- Follow-up appointments (90 minutes): $200.00
- Late Cancellation fee for individuals: $100.00
- Late Cancellation fee for 90-minute sessions: $140.00
- No Show Fee is equal to the amount for the missed session.
Blue Cross/Blue Shield
(BCBS all commercial plans and PPO plans, except for Blue Local)
Carolina Behavioral Health Alliance
CIGNA Behavioral Health
Optum/United Behavioral Health
If your therapy insurance carrier is not listed above, you might have out-of-network benefits that could off-set the cost of services. In order to assist you in determining your own reimbursement from your insurance provider, outlined below are the steps you may take in order to ascertain the actual benefits available to you.
Make sure you keep careful records of your conversation in the event you need to appeal a future decision by the insurance company.
Need help submitting claims for Out of Network (OON) Benefits?
Get Better, Inc. provides an app to make OON claim submission easy. For more information, visit their website: https://www.getbetter.co/
Call the number on the back of your insurance card for the Benefits Department and ask the following questions:
- What is the representative’s name and extension number?
- Does my policy cover an Out of Network, Licensed Professional Counselor 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 session 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 may 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.
My favorite thing about being a therapist is how much of a difference I make and how quickly. Some of my most successful clients were only in need of some understanding and some education. Watching the pieces come together for lasting happiness really makes me love doing what I do.
Tom Murray, PhD–the ONLY doctoral AASECT certified Sex Therapist serving the Triad.