Are you ready for the possibility of a pivotal change and/or getting back to or the re-discovery of your best self?
Given my belief in everyone having access to quality mental health services, I offer a variety of options to connect with me through my practice!
For California-Based Clients: I am currently an In-Network Provider with Aetna, Cigna and Optum, United Healthcare, Oxford, Oscar Health, and UMR
For Ohio-Based Clients: I am private pay only
Beyond the insurances listed above, I am a fee-for-service provider. With this, I am able to offer a Superbill for client’s who wish to seek reimbursement from their healthcare insurance provider as an out-of-network provider. Client’s may also wish to use the source Reimbursify or Thrizer to seek reimbursement.
Sessions are $180 per 50-minute session.
While average session length is 50 minutes, insurance-based session lengths may vary (dependent on insurance provider and coverage).
Due to the volume of work involved for new client intakes, intake sessions are $225.00 and encompass a bio-psychosocial session assessment and treatment planning.
I am also now live on Headway and Alma
Within my work with insurance companies, there is some valuable information that I have learned along the path that I desire my prospective clients to also know so that they can make a well-informed decision on how to best proceed.
Your therapist must diagnose you in order to get reimbursed for your care.
Similar to when you go to a doctor for the common cold, your medical professional must diagnose you in order to be compensated for the medical care provided.
Also, in the mental health field, generally, insurance will not reimburse for difficulties that are associated with your marriage, family difficulties, relationship challenges, grief/ loss, personal growth, values clarification, self-esteem, stress management, or even if the person is just “having a hard time.”
In fact, beyond diagnostic criteria, most of the issues my clients seek out therapy with me for would ultimately not be covered. This is often because many of my client’s are functioning well beyond the basic level managed care/ insurance companies compensate for.
Here are some of the typical therapeutic focus areas that I work with my clients on:
This means (even for couples or family therapy) a person within that treatment unit must meet medical necessity and receive a diagnosis, which may remain a part of their official record permanently. This may not seem like an issue now but what if they need to seek out new medical coverage in the future…a mental health diagnosis could mean the difference between obtaining the preferred coverage or none at all.
Records may not be protected.
When one uses their insurance to receive mental health services, the insurer may have access to your records at anytime they desire via an insurance audit. This could mean that confidential information that you entrusted with your therapist are now exposed to the eyes of the claims specialist.
This exposure may also apply if an individual decides to seek out or apply for high clearance employment or even if you have other reasons for your records to remain confidential. When utilizing private pay, your records remain secure with few exceptions–unless there is a court order signed by a judge or you, yourself sign an authorization for release of records (see informed consent).
Your care is dictated by the insurance company and meeting medical necessity.
Insurance companies require a treatment plan to be submitted by an in-network providers. This means that when individualizing your mental health care and treatment towards the optimal benefit of your needs, your therapist is obligated to share what the focus of your sessions will be, how long you will require treatment, and gain approvals for initial and ongoing treatment. Oftentimes, it may not matter what your therapist decides may be the best approach to your therapy as your treatment will need to fit within the insurance companies/ managed care matrix of decisions. Further, the amount of sessions you will receive is decided ahead of time and may not based on your ideal need(s). Ultimately, it is an overall highly intricate and tangled web and sometimes, despite best efforts, your therapist may not even be compensated for your care.
Insurance Companies almost never pay the full session fee.
Since insurance almost never pays the full session fee, the client may be responsible for the difference between what the clinician charges and what insurance pays. Also, if the claim is denied (for various reasons)…you got it…the client is on the hook for payment for services rendered. If your therapist does not charge the difference…this means your therapist is working for, what may be, less than fair market wage. It is highly recommended that you check with your insurance carrier directly on your coverage so that you may make as well informed of a decision as possible.
Pay cash for sessions…often referred to as “Private Pay.”
This will best ensure–with very few exceptions–your records remain confidential. That is all information between you and your therapist remains between you and your therapist with few exceptions. Further, your care is dictated by what YOU think you need–not your insurer.
If you need to bill insurance, consider an out-of-network provider and submit a SuperBill for reimbursement.
You may pay upfront and your diagnosis will be recorded but it will give you the freedom to choose any clinician/ therapist and your records will be more protected than if you go with an in-network therapist.
If you must absolutely use and bill your insurance with an in-network/ insurance-based clinician, be ready to ask questions, and do your due diligence ahead of time.
Your in-network therapist should be able to discuss what level of transparency the insurance provider expects/ requires. The therapist will likely know what notes may be requested, if a treatment plan is required, and what diagnosis may qualify as a “Medical Necessity” to give you coverage and even if you meet this criteria (via an intake assessment). Asking these questions ahead of time may better support you in determining how you would like to proceed.
Jennifer Hyatt 