Payment, Insurance & Coverage Questions
I accept private pay for clients who wish to maintain privacy or do not have insurance coverage. I also accept the insurance plans listed below.
- Private Pay - Cash & Check
- AllWays Health Partners Preferred (not other AllWays products)
- Blue Cross Blue Shield (most states)
- Out of Network, Preferred Provider Organization (PPO), Point of Service (POS) and Choice benefit products such as:
- AllWays Health Care PPO
- Health New England
- Minuteman Health
- Tufts Healthcare
- Optum/United Healthcare/Unum/Oxford Health/HPHC
For Out Of Network (OON) Payment: I provide a superbill for you to submit to your insurance or FSA/HSA company. You are responsible for your deductible whether you use in network or out of network benefits. After that, for OON you usually pay a percentage of the fee which is somewhat higher than your copayment (e.g., $30 instead of $15). You can call your insurance company and ask for what percentage of the fee they will reimburse after you meet any applicable deductible.
I regret that I am NOT able to accept or bill on behalf of the client for:
If you have one of these insurances, you can access referrals to in network providers when you call the customer service number on the back of your insurance card or use the provider search tool on the website. Most insurance companies have provider search options on their web site as well.
Psychotherapy services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my copayment, coinsurance and deductible and has it been met?
- Do I have out of network benefits?
- Is there a limit on number of sessions or amount per year?
- Do I need an authorization or pre-authorization number?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
- Does my insurance include teletherapy?
Cash and check are accepted for all payments.
If you do not show up for your scheduled therapy appointment, and you have not notified me at least 24 hours in advance, you will be required to pay the full cost of the session because I reserved the appointment for you and could not offer it to others.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS (OMB Control Number: 0938-1401): When you receive emergency care or treatment by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might or might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services: If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may receive after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center: When you receive services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensive services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you receive other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to accept care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to obtain approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, visit: https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.
Request a therapy appointment online here.
Questions? Please us for further information.