What to Know About Using Your Insurance

Self-Pay Policy

As the owner of a self-pay practice, I do not file insurance claim forms for my clients. 

If you would like to use your insurance benefits for reimbursement, you can submit a Superbill to your insurance company. Any reimbursement will be sent directly to you.

Self-Pay Policy

As the owner of a self-pay practice, I do not file insurance claim forms on behalf of my clients. However, your insurance plan may provide "Out-of-Network" benefits that could allow for partial reimbursement of your session fee, which would be paid directly to you. 

To assist you in understanding this process better, click on "Can I Use My Out-of-Network Benefits" below. This link will take you to a helpful Tip Sheet designed to guide you through an informative conversation with your insurance representative.

I enjoy working with seniors in both individual and couples therapy. Many of my senior clients are eager and open to learning new and better ways to navigate the challenges of aging and improve their overall well-being. 

To ensure the long-term sustainability of my private practice, I no longer enter into contracts with health insurance companies, including Medicare and Medicare Supplemental plans. 

However, Medicare does allow clients to self-pay for mental health services through a straightforward process involving a one-page "Opt-Out" form. By signing this form, you acknowledge your decision to work with me as an out-of-network provider and to pay for services out of pocket. I am required to keep this form in my records, and Medicare may request it as evidence of your voluntary choice. 

Additionally, you may not be aware that in late 2024, Medicare expanded its mental health coverage to include a wider range of providers. This change allows Medicare-insured clients greater access to care by adding new categories of professionals.

• Psychiatrists or other doctors (MD, DO)
• Clinical psychologists (PhD, PsyD)
• Clinical social workers (LSW, LCSW, etc.) added 2024
• Clinical nurse specialists (BSN, MSN specializing in mental health)
• Nurse practitioners (NP)
• Physician assistants (PA)
• Marriage & family therapists (MFT) added 2024
• Mental health counselors (LPC, LCPC) added 2024

When deciding whether to use insurance or pay out of pocket, it's important to understand that all insurance companies require a mental health diagnosis to cover services. This diagnosis will become a permanent part of your health record. 

If your insurance policy includes out-of-network benefits, we can still work together. You may be able to submit a claim for reimbursement directly to your insurance company for the amount you paid. In many cases, the reimbursement you receive can exceed what your insurance would pay to an in-network provider. 

For more information, click on the questions below:

• What Questions Should I Ask My Insurance Company Representative?
• What is a Superbill?

Tips-for-Using-Your-Out-of-Network-Benefits.pdf 

If you would like to use your insurance benefits, I encourage you to contact your insurance company directly to verify how your plan reimburses for psychotherapy services.

The Tips for Using Your Out-of-Network Benefits guide (below) can help you navigate this conversation with your insurance carrier’s benefits representative.

If your plan includes out-of-network benefits and you wish to use them, please let me know. I will provide you with a detailed statement called a “Superbill.” This document includes:

• 5-digit billing codes
• Dates of service
• The amount you paid
• A diagnosis code
• Other information required by your insurance company

You will then submit the Superbill to your insurance company according to the filing procedure they outline during your benefits call.

Tips-for-Using-Your-Out-of-Network-Benefits.pdf 

If you would like to use your insurance benefits, I encourage you to contact your insurance company directly to verify how your plan reimburses for psychotherapy services.

1. The Tips for Using Your Out-of-Network Benefits guide can help you navigate this conversation with your insurance carrier’s benefits representative.

If your plan includes out-of-network benefits and you wish to use them, please let me know. I will provide you with a detailed statement called a “Superbill.”

Self-Pay Policy

As a self-pay practice owner, I do not file insurance claim forms for my clients.

If you wish to use your insurance benefits for reimbursement, you may submit a Superbill to your insurance company. Any reimbursement will be sent directly to you by your insurance company.

What Is a Superbill?

A Superbill is a detailed invoice that contains all the information your insurance carrier needs to process your claim for reimbursement.

You can access the “Tips for Using Your Out-of-Network Benefits” form under “What Questions Should I Ask My Insurance Representative?” for guidance when contacting your insurance company.

How to Request a Superbill

If you decide to seek reimbursement:

1. Contact me so I can make the Superbill available through your Client Portal.

2. Inform me if your insurance carrier requires a signed Superbill.

3. Submit the Superbill to your insurance company using their established filing process.

4. A note to current or past members of the US Military or current First Responders receiving my reduced fee in appreciation of your service. Unfortunately, you are ineligible for participation in the Superbill process.

What Information Is Included in a Superbill?

• Therapist information: credentials, contact numbers, and practice address
• Client information: full legal name, date of birth, address, and phone number
• Service details: date(s) of service, type of therapy (individual, couples, family), session length, and any modifier codes
  • Session fee charged
  • CPT Code(s): identifies the session type (e.g., 90834 for a 45-minute individual session)
  • ICD-10 Code: your clinical diagnosis
  • Deductible details: self-pay services will not be reimbursed until your deductible is met. Filing a Superbill ensures your payments may count toward your deductible.
  • Co-pay information: your co-pay requirements may also impact your reimbursement amount.

Important Tips

• Track your submissions: Keep a record of what you submitted, when, where, and how.
• Review your EOBs: Check your Explanation of Benefits (EOB) statements to ensure accuracy.
• Be patient: Reimbursement can be a slow process, so allow time for your insurance company to review your claim.

If you are unable to attend a scheduled session, please cancel at least 24 hours in advance. Cancellations made with less than 24 hours' notice—or missed appointments—may result in being charged the full session fee as a "Missed Appointment Fee." This fee may be charged to the payment source on file in the Electronic Health Record system used by my practice.

Cancellation & Missed Appointment Policy

If you are unable to attend a scheduled session, please cancel at least 24 hours in advance. Cancellations made with less than 24 hours’ notice—or missed appointments—may result in being charged the full session fee as a "Missed Appointment Fee." This fee will be charged to the payment source on file in the Electronic Health Record system used by my practice.

Important Notes About Payment

• Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Health Reimbursement Accounts (HRA): These cards generally do not cover missed appointment fees. Please check with your card provider before attempting to file for reimbursement.

• Insurance Reimbursement: Missed appointment fees are not reimbursable by insurance and cannot be included on a Superbill.

• Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Health Reimbursement Accounts (HRA): typically do not cover missed appointment fees. It’s important to check with your card provider before filing for reimbursement. 

• Insurance Reimbursement: Additionally, insurance reimbursement does not cover missed appointment fees, and such fees cannot be included on a Superbill.