Insurance Guide

I am not in-network with any insurance companies, but I am committed to helping clients access their out-of-network PPO benefits when possible and available.

Here’s how this works: All clients are responsible for paying the full session rate of $225 out of pocket for each weekly session at the time of service.  (Your credit card will be billed each time you have a session.)  However, many clients are able to obtain reimbursement for a portion of their therapy sessions from their insurance company’s out-of-network reimbursement plan.  At the end of each month, I issue a medical receipt called a “superbill” to each client, and you can submit it directly to your insurance provider.

Each client’s eligibility for reimbursement, and the amount of reimbursement each client can expect to receive, varies depending on the details of your plan.  I recommend calling and asking the questions in the below script so there are no surprises later.  The phone number should be on the back of your insurance card under “behavioral health” or “mental health”. If neither of these categories is listed, call the number for member customer service and ask to speak to someone about your Outpatient Mental Health Benefits. Ask the following questions:

1. Do I have out-of-network mental  health coverage?

When you ask this question, the representative may ask you for the “CPT code” or “service code”.  The service code for an Individual Therapy Session is 90834.

If NO – Your coverage will not reimburse you for any part of our visits.  You can either come to therapy sessions and pay in full without expectation of reimbursement, or you can ask the representative to help you find a therapist on your plan.

If YES – Great.  Here are the other questions you want to ask:

2. Can I be reimbursed for my therapist’s license or registration type?

I am licensed as both a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC).  In California, the LMFT is a more common license, so you should mention that one first when asking:

  • First: Can I be reimbursed for sessions with a Licensed Marriage and Family Therapist?
  • If not, then ask: What about a Licensed Professional Clinical Counselor?

3. Do I have a deductible?

A deductible is an amount of money that you are required to pay in a given year before insurance will pay for anything.  If yes, you will want to ask: how much is it and how much is left?

You may also want to ask when does my deductible reset?  This will tell you when you will have to pay your deductible again.  For example, if you have a $500 deductible that resets every January and you schedule your first session in December, you will be paying into your deductible for your first few sessions in December, and then you will have to pay the $500 again in January before your insurance reimburses you some money.

For people with PPO plans, the largest barrier to accessing out-of-network services can be a high deductible.  While some people have $500 deductibles, others have much larger deductibles, up to $10,000 or more.  This is the most important question you can ask in order to determine whether your insurance company will actually send you any reimbursement for your sessions.

4. What is my co-insurance?

A co-insurance is the percentage of the fee that you will be responsible for.  For example, if you have a 20% co-insurance, your insurance will reimburse you for 80% of your fee and you will still be responsible for 20% of your fee.  If your insurance company tells you that they will reimburse you for a certain percentage of the Usual and Customary Rate, that amount may differ from my fee, so you should ask how much it is in order to anticipate how much you will be reimbursed by your insurance company.

When you ask how much the Usual and Customary Rate is, your insurance company may ask you for the zip code of the therapy practice.  My zip code is 91604.

5. Is there a limit to  how many mental  health visits I may receive per calendar year?

If yes, ask how many visits you have per year.

6. Do I need an authorization for my visits?

If yes, ask for an authorization number and number of sessions authorized.

7. Can you tell me the procedure and address to submit a superbill and receive out-of-network reimbursement?

If you encounter any problems or have any questions about this process, I would be happy to answer them for you.  Please note that I am unable to guarantee out-of-network insurance reimbursement.