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Insurance and payment
Insurance:
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At this time I do not accept Medicare or Medicaid/PMAP
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At the current moment, I do accept the following as primary insurance:
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BCBS/Anthem
Health Partners
Cigna
Harvard Pilgrim
Aetna
Amplify/Solarte Health
Ucare
I also accept the following insurance through my billing partner Alma:
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UnitedHealthcare
UnitedHealthcare Shared Services (UHSS)
Oxford
UMR
All Savers (UHC)
Medica (Eligible if the policy is commercial only)
Surest (Formerly Bind)*
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For these insurances, I bill through Alma which you will be invited to join after you book your first appointment. There are no additional charges, it streamlines billing. Click here for updated information.
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Additional costs for out-of-session services and no-shows are in the practice documents on the patient portal.
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Out of Network:
If you are part of another insurance you can request a superbill to submit to your insurance provider to receive out-of-network benefits.
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I can not provide out-of-network services if you are a Medicare or Medicaid member based on federal regulations.
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Additional costs for out-of-session services and no-shows are in the practice documents on the patient portal.
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Private Pay:
The cost of each session is as follows and is billed through Alma:
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Child (<18 years of age) Intake: $400
Child (<18 years of age) Follow-up: $175
Adult Intake: $300
Adult Follow-up: $200
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Additional costs for out-of-session services and no-shows are in the practice documents on the patient portal.
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CPT Codes
Insurance requires that I not overbill or underbill for a particular service. I like to be as transparent as possible so there are no surprises.
The CPT codes I use are typically based on time:
99205: over 60 minutes spend in initial evaluation such as reviewing intake forms, sending medications, etc in addition to the evaluation itself.
99204: under 60 minutes spend in initial evaluation such as reviewing intake forms, sending medication,s etc in addition to the evaluation itself.
90833: 16+ minutes in supportive psychotherapy including psychoeducation.
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The CPT codes I use are typically based on complexity:
99215: severe symptoms with a discussion of higher levels of care or hospitalization.
99214: multiple stable illnesses with prescription drug management *majority of visits*
99213: single stable illness
90785: if there are complicating factors in the visit that impact diagnosis and treatment
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Insurance 101
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What is a deductible?
A deductible is the amount that you must pay for services provided by a healthcare professional before insurance will pay for services. Some insurance plans cover mental health/substance use treatment before a deductible is met.
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What is a copay?
The copay is the amount that you pay once your deductible is met (if you have one) for services that are provided. This is usually a flat dollar amount such as $20 or $30.
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What is co-insurance?
Co-insurance is similar to a copay in that it is what you pay for services once your deductible is met. However, unlike copays, the co-insurance amount is a percentage of the allowed amount by an insurance company (ex: Insurance allows $125 for a service, and your co-insurance is 15%. You would pay $18.75/visit).
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As a reminder, it is ultimately your responsibility to know your benefits. You can find these out by calling your insurance company, and reviewing the "summary of benefits coverage" that you received from your employer or when you purchased your insurance on the healthcare exchange. This can also be found on your insurance company's website, usually via a client portal. As a courtesy, I do verify benefits before starting services, however, there is no guarantee of coverage. Anything that is not covered by insurance is your responsibility.
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