Health Insurance 101
The language of insurance companies can often be confusing. To estimate what you will pay per session, you will want to know a few things about your plan. If you're unsure of any of the answers, the easiest way to obtain the information is to call member services. This information is typically located on the back of your insurance card.
1. What is the name of your insurance plan?
You'll want to know who the provider is (e.g., Blue Cross Blue Shield, Cigna, Optum, Aetna, etc....) as well as whether your plan is a PPO, HMO, or some other variety. If the plan is an HMO, you'll want to know through which health organization the plan operates..
2. What is the difference between a PPO and an HMO?
HMO stands for Heath Maintenance Organization. These plans assign members to a medical group and encourage members to receive services through this group rather than from providers outside the organization. The benefit of these plans is that they typically have a lower monthly premium. Potential downsides are that members are limited to a specific group of providers from whom they may receive services, members require referrals from their primary care physicians to see specialists, and, depending on the plan, insurance benefits may not apply to providers who are out-of-network, or who work outside of the medical group assigned to the HMO.
PPO stands for Preferred Provider Organization. These plans allow members to see a greater number of providers as they are not restricted to specific medical groups. The flexibility to do so often comes at a cost, however, as premiums are likely higher than HMO plans. Members are not required to meet with their primary care physician or obtain a referral when meeting with a provider under a PPO plan.
3. What does it mean to be an in-network provider?
If a provider says that they are "in-network" it means that they have a contract with the insurance company. What this means for you is that you are able to utilize your health insurance benefits. There are many types of insurance plans within a network so it is always wise to contact the number on the back of your insurance card to learn what your out-of-pocket responsibility for sessions will be. For example, some providers may be in-network with Blue Cross Blue Shield PPO but not in-network with Blue Cross Blue Shield Choice PPO.
4. What is my deductible?
A deductible is typically the amount of money you will pay out-of-pocket for services before insurance will begin to reimburse. This often, but not always, includes mental health coverage.
5. What is my co-pay or co-insurance?
A co-pay is a set amount of money you will owe per session. Co-insurance is a percentage of the fee. This is the amount you will owe for each session after your deductible is met.
6. Do I have an out-of-pocket maximum?
Typically, the money to pay toward your yearly deductible, and any co-pay or co-insurance fees for health services, all contribute toward this out-of-pocket maximum. Once you spend this amount on health-related services covered by your plan, the remaining services covered by your plan are usually free of charge. This number differs based on services that are in-network with your insurance policy, or out-of-network.
7. Do I have a maximum number of sessions allowed per year? Per lifetime?
Some plans include these limitations, and some do not.
We encourage you to verify your outpatient mental health benefits prior to our first session. Claims will be submitted as individual psychotherapy sessions conducted in an outpatient setting.
How do I pay for therapy?
Payments may be made by cash, check, or credit card. Receipts are provided. As we’ll discuss during your first visit, there is a fee for missed appointments unless you have provided us with 24 hours notice.
When can I come in?
This may vary by therapist. In general, we are open weekdays, weekends, and some holidays. Many therapists are available after business hours, so you can come at a time convenient for you.
Are there different rates for different therapists?
No, rates are uniform.
What if a therapist doesn't specialize in what I'm dealing with?
You may still reach out and together we can determine if we may be a good fit to work together. If not, we'll gladly provide you with appropriate referrals.
How long and frequent are sessions?
Each of our therapists work differently. Session length and frequency is determined between you and your therapist and is based on multiple factors. It is common for sessions to last 45 to 60 minutes, and while many clients engage in weekly therapy, the frequency and duration will be determined by you and your therapist.
What happens if my therapist and I don’t have a good fit?
We all understand the importance of a good relationship. We want you to feel comfortable with your therapist. You should feel that he or she listens to you, is easy to talk to, is trustworthy, and competent. If you feel you may be better suited for another therapist, simply tell your current one how you feel. This information is not taken personally, and your therapist will help you find someone that is a better fit for you.
is everything I say kept completely private?
Your privacy is important to us and confidentiality is an important piece of the therapeutic process. What you share in therapy is kept confidential with a few exceptions. With your signed permission, we may collaborate with another provider such as your primary care physician or psychiatrist. By law, we are required to break confidentiality and report to the appropriate authorities if we learn that you are a danger to yourself or others or if we learn of actual or threatened harm to those who are vulnerable such as children, elderly, or those with special needs. We'll discuss all of this in greater detail during our first appointment.