Insurance and Fees

Gifted youth

What are the advantages of self-pay?

Choosing self-pay allows for more privacy and choice in format of treatment.  Please be aware of the following for insurance: 

  • Insurance companies require you to authorize us to provide them with a clinical diagnosis of a mental health disorder.
  • When using your in-network insurance benefits the insurance company has the right to access clinical information such as treatment plans and summaries or copies of the entire record. Therapy records may become part of the insurance company record. 
  • Insurance companies may regulate the frequency, number of sessions or length of counseling session.  Self-pay gives you more choice in your course of treatment and allows you to choose which therapist you see.
  • Insurance may limit which types of issues you may receive services for.  Insurance will only cover mental health services deemed medically necessary.

  

In choosing self-pay clinical diagnosis and copies of your medical record will not be accessible to your insurance company and kept confidential as allowed under Ohio law.  Self-pay allows you to receive psychotherapy for what you feel is important without it being determined as medically necessary by an insurance company.  It gives you more control over your privacy, which services you use, what clinician you see and the frequency that you you see them.   

May I use my HSA account?

Yes, you may use your HSA account to pay for mental health treatment..

Are all services covered by insurance?

No, only services that are considered medically necessary are covered.  Many health plans cover mental health services if a client has a clinical diagnosis, but each plan is different.  You need to contact your insurance company to find out the specific benefits of your plan. Counseling and coaching for client's who do not meet the criteria for a mental health disorder are typically not services covered by health insurance.  Marriage/Couples counseling is not considered a medically necessary service and is not covered by insurance. Family counseling is only considered medically necessary when it is to support a family member who is identified with a mental health disorder.

What if I choose to use my insurance benefits?

Many insurance plans have both in-network and out-of-network benefits that cover mental health services. However, insurance benefits and network providers vary.  Therefore, it is important for you to contact your insurance company directly to find out specifics for your individual plan and if your provider is in-network at the location you are planning on seeing them. 


Christy Pulsford MSW, LISW-S, LICDC is an in-network provider for many insurance plans.  Her license, training and education also qualify for out-of-network reimbursement for companies she has not contracted with.  This means that most insurance plans allowing members to go out-of-network for mental health services will reimburse you for a portion of our services, according to the payments they allow. Please Check the nature of your insurance and what it will reimburse you.  


If you choose to use out-of-network benefits we will be happy to provide a CPT code and Statement of Insurance Reimbursement  to assist you in submitting claims.  Another option is to use a service like Better to file a claim.  Please remember insurance companies will only reimburse if they deem it medically necessary and are provided with a clinical diagnosis.  Also, every insurance plan is different and you are strongly advised to contact your insurance provider in order to better understand your mental health benefits and coverage. 


If coverage is denied because of a lack of authorization, you will be responsible for the full fee. In addition, it is advisable that you ask your insurance provider if you have a deductible that needs to be met before benefits are provided, and if your insurance limits you to a certain number of sessions per year. 


Payment, co-pays, and/or deductibles are due at the time of service.  If using out-of-network benefits you are responsible for the entire fee at time of service.  We accept payment in the form of cash, health savings accounts (HSA), VISA, MasterCard, Discover, and American Express.


Click below to find out more information on the on In-Network, Out-of-Network, Self-Pay and the service Better.

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What are the fees?

Most individual psychotherapy appointments are $100 per session.  The diagnostic evaluation (first appointment) and family therapy are slightly higher.  Please review the Professional Services Contract on the forms page for a detailed listing of all fees and more detail on billing.