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:
- For couples FAQ:
- What is couples therapy for?
- Couples therapy is designed to address problems associated with the relationship (e.g., poor communication, conflict, sexual disagreements, infidelity, etc.). Insurance’s objective are (a) to make a profit and (b) to reimburse for medically necessary services that treat medical and/or psychiatric conditions that cause clinically significant impairment. They are not in the business of improving your relationship and your communication skills.
- Do you accept insurance for couples therapy?
- No. Couples therapy is paid out of pocket at the rates shown on this page. You are eligible to use your HSA, if applicable.
- “But, my other therapist saw me and my partner for couples counseling, and they billed insurance.
- While this might have been the case, this implied that one of you had the problem (i.e., psychiatric condition). Our experience is that the problem is in the relationship. You’ve heard the old saying, “It takes two to tango.” When either person has never tangoed, the dance can look like a mess. The mess, however, isn’t evidence that either individual is impaired. The mess is a normal result from this particular context (i.e., two people who do not know how to tango.).
- Ultimately, we are advocates for the relationship. Insurance requires that the therapist be the advocate for the person with the diagnosis; therefore, when a provider bills insurance, the treatment agenda should be set by the patient with the diagnosis.
- “I already have a psychiatric diagnosis.”
- If you already have a psychiatric diagnosis AND you believe that couples therapy will reduce the symptoms of that diagnosis, we recommend that you see the therapist who diagnosed you and request that couples therapy be used to treat your diagnosis.
- “I saw a couples therapist who billed insurance and they didn’t give me a diagnosis.”
- If your health care provider billed insurance, I guarantee you that they assigned you a diagnosis. You can ask that provider about the diagnosis used for billing.
- What is couples therapy for?
- For Individual Psychotherapy to be covered by insurance, does insurance REQUIRE a psychiatric diagnosis?
- Yes. Every time. 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.
- Insurance companies dictate the length of sessions.
- If you use insurance to cover expenses associated with treating a psychiatric condition, the initial session is 45-55 minutes, depending on your insurance contract.
- Initial session: Couples (90 minutes): $240.00.
- Initial session: Individuals (50 minutes): $175.00.
- Follow-up appointments
- 45-50 minutes: $150.00
- 53-60 minutes: $170.00
- 90 minutes: $240.00
- Late Cancellation with 24-hour advanced notice
- 45-60 minutes: $100.00
- 90-minute sessions: $150.00
- No show fee
- Fee is equal to the amount for the missed session.
- Extended Service fee (When sessions exceed permissible length of time)
- 40-45-minute $140
- 15-minute increments: $40
Cancellation Policy: We will charge a late cancellation fee if you do not cancel within 48 hours’ notice or no show fee, as stated in our policies. If forms are not completed within 48-hours of the appointment, we will cancel the appointment.
Paperwork: Please fill out and sign all the client intake forms, including the payment information document, before your first appointment with us. We require all clients to leave a credit card, debit card on file at the time of scheduling. We will charge a late cancellation fee if you do not cancel within 48 hours’ notice or no show fee, as stated in our policies. If you do not receive an email invitation to complete the forms, please contact the office as soon as possible. If forms are not completed within 48-hours of the appointment, we will cancel the appointment.
Blue Cross/Blue Shield
(BCBS all commercial plans and PPO plans, except for Blue Local)
Carolina Behavioral Health Alliance
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 Clinical Mental Health Counselor, Licensed Clinical Social Worker Associated, 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.