Fees
Insurance, superbills, and out-of-network reimbursement
Insurance can be a confusing part of starting therapy. Here is an explanation.
Plans I'm in network with
Aetna and UnitedHealthcare. If you have either, you'll typically pay only your copay at the time of the session, and I bill your plan directly.
One thing worth knowing if you have UnitedHealthcare: mental health benefits are administered through Optum rather than UHC's medical network, so searching the general UnitedHealthcare directory sometimes won't surface therapists who are in fact in network. Look under Optum or behavioral health, or just ask me on the consultation call and I'll confirm. Please be aware that insurance needs a diagnosis to bill – we'll collaborate on this together.
Every other plan – how superbills work
A superbill is an itemized receipt with everything your insurer needs to reimburse you: the dates of service, the fee, my license and NPI number, and the diagnostic and procedure codes. You pay me at the time of the session, submit the superbill to your insurer, and they reimburse you directly according to your out-of-network benefits.
I generate a superbill for each session, available through the client portal. Most insurers now accept them through an app or an online portal, and the submission takes a few minutes.
The five questions to ask your insurer
Call the member services number on the back of your card and ask for behavioral health benefits. These five answers tell you what therapy will actually cost you:
- Do I have out-of-network outpatient mental health benefits?
- What is my out-of-network deductible, and how much of it have I met this year?
- Once the deductible is met, what percentage of the fee do you reimburse?
- Is reimbursement based on my provider's actual fee, or on your allowed amount? (This one matters most and people never ask it.)
- Is there a limit on the number of sessions per year, and do I need prior authorization?
Write down who you spoke to and the reference number. It helps if anything is disputed later.
Common questions
- How much will I get back with an out-of-network plan?
-
It depends entirely on your plan. Reimbursement rates vary widely and I can't guarantee any amount – only your insurer can tell you. The five questions above will get you a real number.
- Is couples therapy covered?
-
A portion might be. Insurance reimburses treatment of a diagnosed mental health condition in one identified client, and relationship difficulties on their own generally don't qualify. Confirm with your insurance plan to find out if it's covered.
- Can I use an HSA or FSA?
-
Yes. HSA and FSA cards are accepted in the client portal, the same as any other card. Therapy is an eligible medical expense under both.
- Do you take Medi-Cal or Medicare?
-
Not at present. I'm not currently credentialed with either, so I can't bill them. Medi-Cal credentialing, including CalOptima, is something I'm working toward, so it's worth asking on the consultation call where that stands.
- What if I don't want a diagnosis on file?
-
Then paying privately is the cleaner route. See fees