Choosing self-pay allows for more privacy and choice in format of treatment. Please be aware of the following for insurance:
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.
Yes, you may use your HSA account to pay for mental health treatment..
An Employee Assistance Program (EAP) is a work-based program that may offer free or discounted mental health assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related concerns. EAPs differ greatly depending on the employer and are not offered by all employers. The provider list for EAP programs can also differ from your insurance company's provider list. Please check with your human resources or EAP department to inquire about the specific benefits offered by your employer and if your provider will be covered under these benefits.
No, only services that are considered medically necessary are covered. Many health insurance 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. Psychotherapy, 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. Additionally, treatment is not considered medically necessary for all mental health disorders diagnosed. 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.
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 due to lack of authorization or a claim adjustment is determined by your insurance carrier, you will be responsible for the full service 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.
Most individual psychotherapy appointments and consultations are $100-$125 per session. Some services including but not limited to diagnostic evaluations are higher. Please review the Consent for Treatment on the forms page for a detailed listing of all fees and more detail on billing.