Because we are out-of-network providers, clients pay us the full fee directly. However, many of our clients are able to obtain reimbursement for a portion of their therapy sessions from their insurance company. After each session, we issue a medical receipt called a "superbill" to each client, which you can submit 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. We recommend calling and asking the questions in the below script so there are no surprises later.
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." Here are the codes for services we provide:
Individual Therapy Session (just you coming for therapy) - 90834
Couples or Family Therapy Session (you coming to therapy with your significant other or a family member) - 90847
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. Is a diagnosis code required for reimbursement?
If yes, ask if Generalized Anxiety Disorder (F41.1) is covered.
3. Can I be reimbursed for my therapist's license or registration type?
Some insurance plans will not reimburse for services rendered by pre-licensed therapists, which some of our therapists are. If you see Katie Miller or Dene Selkin, you may want to ask if you can be reimbursed while seeing a "Registered Associate Marriage and Family Therapist."
4. 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.
5. 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" or "Allowed Amount" that amount may differ from our 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. Our zip code is 90405.
6. 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.
7. Do I need an authorization for my visits?
If yes, ask for an authorization number and number of sessions authorized.
8. 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, we would be happy to answer them for you. Please note that we are unable to guarantee out-of-network insurance reimbursement.