Rates and Fees

An “out of network” or “private pay” therapy practice is one that does not accept insurance directly. This means that they are not contracted with any insurance companies or managed care companies (where you only pay a copay). You pay directly for your care at the time of service and then, if eligible, you may be reimbursed for services by submitting a Superbill.

The conscious decision to not work with insurance was made for A LOT of reasons:

1. Insurance companies require that your child be diagnosed the very first time a therapist meets them, regardless of assessment process.

2. These diagnoses stay in a medical record permanently and can be used against clients if they were to apply for specific insurance policies (such as short-term disability) or in the case of applying for certain career positions.

3. Insurance companies do not pay for preventive mental health care. Oftentimes, getting treatment for “sub-clinical symptoms” (read: challenges that do not meet criteria for diagnosis) can be EXTREMELY beneficial - especially with anxiety, which is progressive (it gets worse over time).

4. Insurance companies require that therapists sacrifice your right to privacy and confidentiality through reviews that require sharing personal information, sometimes even notes, from sessions.

5. Insurance companies dictate treatment by approving only certain kinds of therapy and sometimes only a certain number of therapy sessions.

You are responsible to pay your rate at the time of service. While this may seem like a bummer at first, it allows your services to remain creative and confidential, when possible. I’m able to invest more time into your treatment and stay up to date on the best practices for the challenges you are facing.

Although I do not accept insurance directly, I will happily provide you with the documentation (called a superbill) that you need to get reimbursed for therapy services - if you are eligible.

You submit the documentation to your insurance company, which includes a medical diagnosis code, specific codes for sessions, and more, and they reimburse you directly based on your plan.

Depending on your plan, you may have “out of network” benefits that allow you to be reimbursed (partially or fully, depending on your plan) for our services.

It may seem a little complicated at first, but many of our clients navigate this process with little difficulty. We recommend calling your insurance company directly, and asking them the following question: Do I have out-of-network benefits?

If not: Talk with your HR representative about how you can sign up for a plan with out-of-network benefits during your next open enrollment period.

If you do, ask the following questions:

1. What is my out-of-pocket responsibility?

2. What is my out-of-network deductible for outpatient mental health?

3. How much of my deductible has been met this year?

4. What is my reimbursement rate for (we most commonly use the service codes below)…?

   • 90834 - Individual Therapy, 50 minutes

   • 90846 - Family Therapy without Client Present

   • 90847 - Family Therapy with Client Present

   • 90853 - Group Therapy

5. Is there an "allowed charge" that is used to determine my reimbursement rate, and if so, what is the "allowed charge" for each of the service codes?

6. What is my reimbursement rate for telehealth services (even if you aren’t planning to use telehealth regularly- this is good to know in case you need to use this in the future)?

7. Do I need a referral from an in-network provider to see someone out of network?

8. Do I need any other prior authorization to receive these benefits?

9. How do I submit claim forms for reimbursement?

10. Is there a deadline for my reimbursement?

11. Is there anything else I need to do?

**Some insurance companies will NOT reimburse for services provided by anyone other than an independently licensed clinician (LCSW-C/LCPC). If you are going to work with an LMSW/LGPC, please ask your insurance company about this directly.

There is no reimbursement possible for work with Graduate Interns.

We cannot guarantee reimbursement at any time.

If you are concerned about paying out of pocket for services, please reach out directly via email to courtney@healinghartwellness.com. If nothing else, I am able to provide you with referrals to in-network therapy.