How we work with insurance companies:
We accept payment up front from clients. We provide clients with an invoice which can be submitted to insurance for reimbursement. However, we will work with you to come up with a payment plan that works for you. For example, most insurance carriers will reimburse customers if they go out of the network for behavioral health services. Each carrier has a “reimbursement rate,” some percentage of the fee. For example, for $100 per hour, if the insurance company has a 50 percent rate, the customer will be reimbursed $50 of the $100. So this means you can pay us up-front, $50 … and then “back-end” the remaining $50 after 6 weeks. Six weeks gives you enough time to submit your expense to the carrier and then get reimbursed.
There are several reasons why we choose to go with a private pay system.
Insurance companies must balance care with profit … while we put care before profit. Profit is largely dictated by cutting costs. Managed Care dictates the quickest and most efficient care as possible. Cost savings is paramount. To be part of an insurance company’s “network,” the therapist submits treatment plans for each patient that place a high emphasis on cost effectiveness and the quickest care possible – regardless of what might be in the best interest of the client. Some clients may only require a few sessions. Other clients may require more sessions. And other clients may benefit from other types of therapeutic approaches that do not “fit” the insurance company model. Out of Network reimbursement may not cover as much for the client, but in return the client dictates what is best for him/her…. not the insurance company.
Insurance companies are asking for more detailed, mental health information about clients from therapists. If an insurance company does not believe the therapist is working in a cost effective manner, it may ask for detailed information about the client. Insurance companies can audit therapist’s files AND withhold payment to therapists.
Insurance companies apply “Medical Necessity” in a strict sense to behavioral and mental health clients in order to save money and earn profit for the company. Around the country, more therapists, psychiatrists and providers are moving away from the insurance company profit model towards fee-for-service. Again, this is another reason why we offer sliding scales. We will work with you, to see how many out of network sessions you have, what your reimbursement rate is, and to come up with a payment plan that is fair to you and to us.