How payment works

How Payment Works

This is an out-of-network, private pay practice. This page will help to explain how it works.

Payment and Claims

I do not bill insurance directly. Your credit or debit card information is stored securely in SimplePractice, a HIPAA-compliant platform. All payment details are encrypted and protected, and your card is charged on the day of your scheduled appointment.

New patients begin with the New Patient Package: a 2-hour evaluation, a 50-minute follow-up, and a written treatment plan. The package is paid as one fee on the day of your evaluation, and the follow-up and treatment plan are included at no additional cost. Learn more about the package

After each visit I can provide you with a superbill upon your request. It is an itemized receipt containing everything your insurance company needs. You submit it to your plan, and any reimbursement is sent directly to you. The amount reimbursed depends on your insurance plan and out-of-network deductible.

Fees depend on the type and length of appointment. We will go over them with you during the intro call, before you schedule.

How Out-of-Network Reimbursement Actually Works

1
Check your benefits. Call the number on the back of your insurance card and ask whether your plan has out-of-network outpatient mental health benefits. If you have a PPO or POS plan, you probably do. HMO and EPO plans usually do not.
2
You pay at the time of your appointment.
3
A claim goes to your insurance company. It lists the date, the service provided, and the diagnosis.
4
Your deductible comes first. Most plans have a separate out-of-network deductible. Until you have met it, you pay the full fee, and every visit counts toward it.
5
After the deductible, your plan reimburses a percentage. Insurers do not reimburse a percentage of what you paid. They set their own allowed amount for the visit and reimburse a percentage of that.

A Worked Example

Here is what that looks like with round numbers. These figures are for illustration only and are not this practice's fees.

Say a visit costs $400 and you have met your deductible. Your plan sets an allowed amount of $250 for that visit and reimburses 70% of it. Your insurer sends you $175. Your net cost for the visit is $225.

For some plans with good out-of-network benefits, the cost after reimbursement ends up much closer to an in-network copay than people expect. For others it does not. The only way to know is to check your specific plan.

What to Ask When You Call Your Insurance Company

Call the member services number on the back of your card and say you want to check your out-of-network outpatient mental health benefits. Then ask these, and write down the answers along with the date, the time, and the name of the person you spoke to.

Do I have out-of-network benefits for outpatient mental health?
What is my out-of-network deductible, and how much of it have I met so far this year?
Once the deductible is met, what percentage do you reimburse?
Is that percentage based on the amount I was charged, or on your allowed amount for the service?
How do I submit a claim, and what is the deadline for submitting one?

Questions About Cost or Coverage?

We are glad to walk you through it.