PAYMENT FOR INDIVIDUAL, COUPLES OR GROUP THERAPY
I primarily offer self-pay therapy, but I am also an out-of-network provider for many insurance plans. If your insurance plan has an out-of-network benefit, they will generally cover a percentage of my fee after you have met your deductible.
PAYMENT FOR COACHING
Payment for coaching services is not covered by insurance. I am happy to schedule a complimentary coaching call to learn more about your goals and discuss a plan that is tailored for you. If you’d like to learn more, please contact me today.
Insurance never seems to be as straightforward as it should be, so here is some helpful information to make this portion of the process as smooth as possible.
1. Do you accept insurance?
Using insurance to pay for therapy is certainly an option, but it can impose some limitations and restrictions on how we manage your treatment. Many clients prefer to pay for their treatment on their own, since it does provide more privacy and freedom regarding your therapy choices. However paying privately for therapy can be costly, so some of my clients opt to use their insurance to pay for our work together. Here are a few helpful details concerning insurance:
- I am an out-of-network provider for clients who have out-of-network benefits through Cigna, Aetna, United Behavioral Health, Tufts, Harvard Pilgrim Health Insurance, or Blue Cross/Blue Shield of Massachusetts.
- If you choose to use your insurance, please contact your insurance company prior to our first visit to verify your benefits and get clarification about the limits of your coverage, authorizations, deductibles and co-payment amounts. Also, please bring your insurance card and payment to the first visit.
2. How does insurance work?
Insurance can be very confusing and it is important that you understand the intricacies of your policy, as you are responsible for co-payments, deductibles, and fees for therapy if your coverage expires. I encourage you to call your insurance company to get clarification about what they will and will not cover, and to find the answers to the following questions:
QUESTIONS TO ASK YOUR INSURANCE PROVIDER:
- Do I have behavioral health or mental health benefits?
- Does my particular plan have an out-of-network benefit?
- Is Theresa Cohen an out-of-network provider for my particular plan?
- Do I have a deductible, how much is it, and has it been met?
- After my deductible is met, what percentage of the fee does my plan cover?
- How many sessions does my plan cover, and in what time period?
- Do I need an authorization to begin outpatient therapy?
- Is approval required from my primary care physician?
- How do I access the form(s) needed to submit a request for reimbursement?
3. What types of payment methods do you accept?
I accept payment by cash, check, debit/credit and flexible health spending cards. Payment is due at time of service. Many of my clients choose to keep a debit or credit card on file for payment of fees and can be assured that their cardholder data is protected and secured in accordance to Payment Cardholder Industry Data Security Standards.
4. Why would someone choose not to use his or her insurance?
As mentioned above, sometimes using insurance to pay for therapy can impose some limits or restrictions on our work together.
It is important to be aware that in order for your insurance company pay for your therapy, you must be given a psychiatric diagnosis from the American Psychiatric Association’s Diagnostic and Statistical Manual. As part of your medical history, this diagnostic label and your therapeutic information could affect your eligibility or premiums for your life/disability insurance. Additionally, managed care insurance companies may require the release of clinical information regarding your therapy in order to authorize visits beyond those initially approved, and they may only agree to pay for sessions if the insurance company deems it to be “medically necessary”.
Clients who elect to self-pay, instead of using their insurance, often do so because they do not want or need a psychiatric diagnosis, they do not meet “medical necessity” insurance requirements, or because they wish to meet more frequently than their insurance plan allows.
When deciding whether or not to use your insurance for therapy, it can be useful to weigh the advantages and drawbacks associated with insurance versus paying for treatment on your own. I encourage you to contact your insurance company directly to find out more about their privacy policies, limits of treatment, and authorization requirements for future sessions. Additionally, I am available to help you explore this issue and support you in your decision making process.