Insurance and Fees

---

Most psychotherapy appointments with this provider cost $130-$150. A detailed listing of fees can be found on the Informed Consent for Treatment located on the forms page. Rates vary by length and type of service. All services will be charged as self-pay unless you specify a reimbursement plan through EAP (e.g., Lyra Health) or insurance (e.g., Custom Design Benefits, TrueCost and Medical Mutual) benefits at scheduling. Upon request, a Good Faith Estimate will be provided for self-pay appointments through the client portal. 

Choosing self-pay allows for more privacy and flexibility. Please be aware of the following for insurance: 

• Insurance companies require us to provide them with a clinical diagnosis of a mental health disorder, which will become a part of their records. 
• Health insurance will only cover mental health services deemed medically necessary. However, life is full of challenges, and counseling is often helpful even if it doesn't qualify as a medically necessary service. Talking with a trained professional can help you manage change, find balance, and achieve goals.
• When using health plan benefits, the insurance company can access clinical information such as treatment plans and summaries or copies of the entire record. Medical records are exempt from insurance reporting and compliance audits when choosing self-pay.
• Insurance companies may regulate the therapy session's location, frequency, or length. Self-pay gives you more choice in your course of treatment and allows you to choose which therapist you see.

When choosing self-pay, a clinical diagnosis and copies of your medical record will not be accessible to your insurance company. Information will be kept confidential as allowed under Ohio law. Self-pay will enable you to receive psychotherapy or counseling for what you feel is important without an insurance company's determination of medical necessity. It gives you more control over your privacy, which services you use, what clinicians you see, and the frequency you see them.   

Clients often use their HSA or FSA funds to cover self-pay, deductible, and copay amounts. You may use your HSA or FSA account to pay for medically necessary mental health care. Although most services qualify as medical expenses, there are some exceptions. Please check with your company to verify if services are considered a medical expense.

An Employee Assistance Program (EAP) is a work-based program (e.g., Lyra Health) that may offer employees free or discounted short-term counseling. Not all employers provide EAP programs, and the provider list for EAPs can vary from your health insurance company. Please check with your human resource department or employee assistance program to inquire about the specific benefits offered by your employer.

Most health insurance plans cover mental health care, but each plan differs. You need to contact your insurance company to find out the specific benefits of your plan. For clients with a primary address in Ohio, we will directly file insurance claims for in-network plans (e.g., Custom Design Benefits, TrueCost and Medical Mutual). Please keep in mind that health insurance plans only cover medically necessary services under a qualifying clinical mental health diagnosis. EAP programs may cover the cost of short-term counseling services without this requirement.

Psychotherapy and counseling for clients who do not meet the criteria for a mental health disorder are often not considered medically necessary services and, therefore, not covered by health insurance. Most insurance plans do not regard marriage/couples counseling as mental health care. Family counseling is only considered medically necessary to support a family member in treatment with an identified mental health disorder. 

Click below to find out more information on In-Network and Out-of-Network coverage.

When not using in-network insurance or EAP benefits, you have the right to receive a written “Good Faith Estimate” of your medical expenses under the No Surprises Act, which was implemented in January 2022. 

A Good Faith Estimate is a written statement of the expected cost of treatment. The price of psychotherapy with this provider is determined by length, reflecting the Current Procedural Terminology (CPT) published by the American Medical Association. Treatment costs are clearly defined in the informed consent and will be discussed with you upfront. In addition, under 2799B-6 of the Public Health Services Act, upon request, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. 

If a Good Faith Estimate for the total expected cost of any non-emergency items or services scheduled in advance is requested, it will be uploaded to the client portal. You may view it and print it from the client portal.

• You can ask for a Good Faith Estimate before scheduling a service or during treatment. 
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute it. 

For more information about your right to a Good Faith Estimate, please visit https://www.cms.gov/nosurprises