Questions about Insurance and Payment

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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 kept confidential under Ohio law. Self-pay allows you to receive psychotherapy 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 is contracted with Lyra Health. 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 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 records. Using an in-network provider, you are usually only responsible for your co-pay and 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. Also, insurance companies may only reimburse for a limited number of sessions. Please contact your provider to see what insurance companies they have chosen to contract with.

We will file insurance claims for Custom Design Benefits, Medical Mutual, and Humana directly with the company. All you need to do is provide your clinician with a copy of your insurance card.  

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 then 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 the same limitations as those with an in-network provider. 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 plan. We will file insurance claims for in-network plans directly with the company. Some in-network plans include but are not limited to Custom Design Benefits, 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, sign appropriate consents, and provide your clinician with a copy of 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 be happy to provide a CPT code and Statement of Insurance Reimbursement (superbill) to assist you in submitting claims upon request. Requests must be made prior to the appointment. 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. Every insurance plan is different, and you are strongly advised to contact your insurance provider to understand your mental health benefits and coverage better. 

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.

One option for out-of-network claims is to use a service like Better. Better can file your out-of-network claim for you and determine your eligibility.

For In-Network services, you will need to contact your insurance directly to ask about benefits. If you want to file your out-of-network claims, you must contact your insurance company directly. Insurance plans vary greatly even within a company.  

Helpful questions to ask your 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 percentage 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?

You may file the claim yourself or use a service like Better. Better is a service that can simplify the process of reimbursement. You can either download the app on your phone or signup online. Out-of-Network reimbursement is as simple as sending them a picture of your insurance card and forwarding them the superbills. Superbills are a Statement of Insurance Reimbursement that your clinician will send you. For all claims filed towards the deductible or otherwise deemed ineligible for reimbursement, Better is free of charge. Better charges the 10% service fee for the insurance reimbursements received. 

You may also choose to file the claim yourself with no service fee.  Your clinician will provide you with superbills directly if you want to send your claims yourself. Discuss with your clinician how to do this, and they will be able to assist you by providing the proper documentation.

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