INSURANCE AND FEES
Are you wondering whether your insurance will help pay for therapy?
Navigating insurance coverage for mental health care can feel like a second job. If you have been searching for therapist and hitting dead ends with your plan, you are not alone and you have more options than you might think.
You may have more coverage
than you realize.
I am not in-network with most insurance plans, which means I do not bill your insurance directly. But that does not necessarily mean you are on your own with the cost.
Many insurance plans include out-of-network benefits that allow you to be reimbursed for a portion of what you pay out of pocket. After sessions I provide you with a superbill, which is a detailed receipt you can submit directly to your insurance company. The key code your insurer will need is CPT code 90834, the standard code for a 45-minute individual therapy session.
My fee is $212 per session.
Depending on where you live, your insurance may be required to cover my services.
Several states have laws requiring insurance companies to maintain adequate networks of mental health providers. If your insurer cannot connect you with an in-network mental health specialist within the required timeframe, you may have the right to see me at in-network rates.
Illinois: If no in-network mental health provider is available within required travel time or within 10 business days for an initial appointment, you must be covered at in-network cost.
New Hampshire: Has wait time and distance standards for mental health services but no clear mandate for out-of-network coverage when those standards are not met. It’s worth asking your insurer.
New Jersey: Stronger legislation is pending. Current rules require mental health coverage in networks. It’s worth asking your insurer.
New York: If your insurer cannot provide an in-network mental health specialist in a reasonable timeframe, they may be required to cover out-of-network care at in-network rates.
Before your first session, call the number on the back of your insurance card and ask:
Do I have out-of-network mental health benefits?
What is my out-of-network deductible, and how much has been met?
What will be reimbursed per session once my deductible is met?
Is CPT code 90834 covered under my plan?
A note for Medicare beneficiaries
I have opted out of the Medicare program. This is different from being out-of-network. It means Medicare will not reimburse sessions with me, even partially, and you would be responsible for the full fee. If you have Medicare as your primary insurance, please reach out before scheduling so we can talk through whether working together makes sense for your situation. Some people with Medicare also carry a secondary or supplemental plan that may cover services Medicare does not, and that is worth exploring.
I provide invoices and/or superbills to help you use your out-of-network benefits and make the insurance reimbursement process as seamless as possible. I accept Health Spending Accounts and Flex Spending Accounts.
Please note that if you have mental health coverage through your insurance company, you may be able to obtain services at a lower cost from an in-network provider.
If you choose to work with me, or any out-of-network provider, you will be provided with a ‘good faith estimate’ of what services will cost.
Not sure where to start?
I put together a free guide that walks you through the whole process, including what to say when you call your insurance company, a note on federal plans like Tricare, and information about New York's network adequacy law.
Questions?