Why don't we directly bill insurance companies?
There are a number of reasons for which we do not directly accept and bill insurance. The main reasons are:
1) A therapist has to diagnose someone to get reimbursed.
When a mental health provider directly bills your insurance for counseling or psychotherapy services, your insurance requires a lot of personal information about you to ensure that you have a “medical necessity” which requires the need for mental health and counseling services.
“Medical necessity” means that you have a mental health diagnosis that is severe enough to be impacting your daily functioning, meaning your ability to get your day to day things done (e.g. work, school, social interactions, activities of daily living such as bathing, eating, etc.). This means that a therapist directly billing your insurance needs to make a strong justification for what your diagnosis is and how it impairs you from being a functional individual.
Insurance doesn't reimburse for "marriage therapy" or "I'm having a hard time" or even "grief". It is a medical model, and so this means that payment can only be for a diagnosis. This means that (even in family therapy) one person must receive a label. And these labels will be part of your official record, permanently. This might never matter to you. If you are one of the fortunate ones who has medical, life and disability benefits through your employer... you might never worry about this. But if you're someone who might ever be unemployed, self-employed, or need to purchase your own benefits- a mental health diagnosis can make the difference between preferred coverage or none at all.
2) Your care is dictated by the insurer
Most insurance requires some sort of treatment plan to be submitted by in-network providers. This means that (rather than giving you the care that best fits your needs) the therapist is responsible to the claims representative (usually a non-mental health professional) for how you spend your time. To put it simply, an in-network therapist works for the insurance company, not you. It doesn't matter what you and your therapist decide is in your best interest, it needs to fit their matrix of decisions. It also must fit within the allotted sessions which are determined ahead of time, not based on need. Also, this treatment plan becomes a part of your permanent record with the insurance company.
3) Your records are not protected.
Your insurer can audit your records at any time they wish. This means any details that your therapist might not have included in the paperwork (perhaps for good reason) is technically open to the eyes of any "claims specialist" the company hires. Again, this might not matter to you. But if you hold high clearance for a job or have other reasons you want your information to be held confidential, this is important to know.
However, we know that sometimes using insurance can really help the financial aspect of any type of treatment.
Dr. VanderKaay and David are both Out-of-Network or Non-Contracted Providers for national insurance companies (Anthem Blue Cross, Blue Shield, Aetna, Magellan, etc.).
Many insurance companies will reimburse if you receive services from an Out-of-Network or Non-Contracted Provider. This reimbursement works differently as there is no contracted reimbursement rate. Insurance companies will typically reimburse either a set amount (for example, $45/session, no matter the cost of the session) or a percentage of the session cost (for example, 50% of the amount billed). You are then responsible for paying the difference between what the therapist charges ($100/session, for example), and what the insurance company reimburses (for example, 50%, or $50). At CMMF, we require that you pay the full fee at the time of service and then submit a Superbill for reimbursement.
We offer a monthly Super Bill to clients who request them for reimbursement purposes.
A Super Bill itemizes the services rendered, how much you paid for your services, and a diagnosis that is enough for the insurance carrier to pay you back a portion of the fees you paid for your services. (That is, unless the service is for marriage counseling, which is rarely covered, as discussed earlier.) Most often those of us who offer Super Bills to our clients refer to ourselves as “Out of Network” providers, meaning, we are outside of your insurance company’s preferred provider network, but that some of the fees for our services might be reimbursable to you directly through your insurance provider. This is typically only applicable to people who have PPO type insurance plans. This is also what you need to file using Reimbursify (see above).
Please note, it is ultimately your responsibility to understand your insurance benefits and to make sure what percentage of the therapist’s fees will be reimbursable.
If you are considering counseling services, don’t let the cost of the services scare you away. Insurance is a great resource to have, and can be helpful, but in reality, investing in your overall wellbeing is a more cost-effective way of managing your health. A part of that wellbeing includes investing in a really good counselor with whom you connect who can help you on your current journey through life. After all, it is more important to invest in your health early on rather than experiencing greater struggles later on in life.
Keep in mind, sometimes paying more out of pocket for someone who you really connect with that is outside of your network can really make a big difference in how the therapeutic process works for you.
We strive to be the counselor with whom you can really connect. Let’s partner together and let your healing process begin.
