Questions about Insurance and Payment

---

Self-pay means you choose not to use your insurance benefits to pay for services. Medical records are exempt from insurance reporting and compliance audits. Clinical diagnosis and copies of your medical record will not be accessible to your insurance company and will be kept confidential under Ohio law. Self-pay allows you to receive therapy for what you feel is important without being determined as medically necessary. It gives you more control over your privacy, which services you use, what clinicians you see, and the frequency you see them.  

EAP stands for Employee Assistance Program. It is a work-based program that offers employees various services to help their overall well-being. The program can assist with personal or work-based problems. Free or discounted short-term counseling is typically one of the services and is often available for all employee family members.

Not all employers provide EAP programs, and your company's provider list for EAPs can vary. This provider accepts Lyra Health benefit plans. Please check with your human resource department or employee assistance program to inquire about the benefits offered by your employer and to attain authorization for benefits. 

If your provider is in-network, they signed a contract with your insurance company to accept a specific rate (often a discounted rate) and complete paperwork in the format directed by the insurance company. It also means they have agreed to give the insurance company access to your medical record. Using an in-network provider, you are usually only responsible for your co-pay or deductible for services covered by your health plan. Remember that health insurance only covers services if they are considered medically necessary. They do not cover all services or late cancellation fees. Using an in-network provider, the insurance company can access your medical records to determine medical necessity. Please contact your provider to determine which insurance companies they have contracted with.

For clients with a primary address in Ohio, we will file insurance claims for in-network plans (e.g., Custom Design Benefits, TrueCost and Medical Mutual) once you provide your therapist with a copy of your insurance card and sign appropriate consent.  

Out-of-network providers have not signed a contract with the insurance company. Therefore, you are responsible for the entire fee at the time of service, and your insurance company will reimburse you for a portion of the cost according to the payments they allow. Please check the nature of your insurance and what it will reimburse you. This can save you money over self-pay, but benefits will likely fall under limitations. Clinical information must still be provided to the insurance company to use out-of-network benefits. Not all insurance plans have out-of-network benefits, and not all benefits work the same, so it is essential to contact your insurance company and verify your benefits.

Christy Pulsford MSW, LISW-S, LICDC is an in-network provider for some insurance plans. Please contact your insurance provider to inquire if services will be in-network under your specific plan. We will file insurance claims for in-network plans directly with the company for clients with a primary address in Ohio. In-network plans include but may not be limited to Custom Design Benefits, TrueCost and Medical Mutual and Humana. If in-network, all you need to do is specify when scheduling the appointment that you would like to use your insurance benefits for therapy, sign appropriate consents, and provide your clinician with your insurance card. You will be responsible for co-pays, deductibles, and any service fees not covered by your plan. Fees charged for missing an appointment with less than 24-hour notice are not covered by insurance.

Her license, training, and education qualify for out-of-network reimbursement for most companies she has not contracted with. If you choose to use out-of-network benefits and treatment is considered medically necessary, we will happily provide a CPT code and Statement of Insurance Reimbursement (superbill) to assist you in submitting claims upon request. Requests must be made before the appointment. Please remember insurance companies will only reimburse a portion of the cost of therapy. Health insurance only covers medically necessary services with a clinical diagnosis. Every insurance plan is different, and you are strongly advised to contact your insurance provider 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 entire service fee. In addition, you will be responsible for any fees not reimbursed by the insurance company within 60 days of the claim being filed. 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 deductibles are due at the time of service. If using out-of-network benefits, you are responsible for the entire fee at the time of service. We accept payment through checks, health savings accounts (HSA), VISA, MasterCard, Discover, and American Express.

Please review the Informed Consent for Treatment for more detailed information on fees and billing when using insurance benefits.

Contact your insurance company directly to ask about benefits. Insurance plans vary greatly, even within a company.  

Once I find a therapist near me, helpful questions to ask the insurance company:

• What is my deductible, and has it been met?
• Do I have mental health benefits?
• How many mental health sessions per calendar year does my insurance cover?
• Is Christy Pulsford GrowthINsight Counseling LLC an in-network or out-of-network provider?
• Do I have out-of-network benefits?
• What am I reimbursed for routine behavioral health care out-of-network?
• What is the reimbursement for CPT codes 90791, 90834, 90837, and 90847?
• Do you require pre-approval or pre-certification?
• Is there anything else I should know?

If you have further questions or concerns about payment options, please discuss them with your clinician or insurance provider.