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Questions About Insurance…

Many new clients to my practice often have questions about insurance coverage and my reason(s) for not participating directly with insurance companies. The services I offer to my clients (individual, couple, family and group therapy) are often covered in part by insurance but I do no accept insurance directly.

In these complex financial times, I feel that it is important to stress that my practice has always been devoted to providing the best value in the services provided. I work with some clients (based on financial need) on a “sliding scale” rate to make therapy possible for them.

You may be able to go to an in-network provider for less expensive/smaller co-pays. I believe there is value in seeing a therapist that you chose on factors beyond insurance plan participation. My fees are comparable to other out-of network therapists in the tri-state area. My referrals do not come from insurance companies, rather my clients choose to work with me based upon reputation and professional quality.

I am considered an “out-of-network provider” for most PPO plans, and most flexible spending plans or HSA-Health Savings Accounts typically consider therapy services rendered by an LMFT (licensed marriage and family therapist) to be qualifying expenses.

I do not call, write of fax insurance companies about your treatment. Instead, I provide detailed monthly information directly to my clients that can be shared with an insurance company. This might include an itemized invoice with all the necessary codes and numbers for reimbursement, or more detailed documentation that your insurance company may request.

Below you will find some points which detail why I currently operate my practice in this way:

  • Technically, health insurance benefits can only be used to treat an “illness”. As such, therapists are required to give a diagnosis code when treatment is submitted. Many of the clients that I work with do not fit into a diagnostic category; they come to therapy  to learn new skills or be supported. These cases do not necessarily require a diagnosis.
  • The health insurance industry has recently undergone drastic changes. Many people now have high deductible policies. This means that I would be filing a diagnosis while no benefits would be paid during much of the treatment.

Should you have any questions about fees and my insurance policies, please don’t hesitate to contact me.

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