Will insurance pay for my therapy sessions?
If your insurance plan includes out-of-network mental health/behavioral health coverage, you will most likely be eligible to have some or all of the cost of sessions covered.
How do I find out if My insurance Plan includes out-of-network COVERAGE?
This can easily be determined with a 5-minute phone call to your insurance company. Simply call the Member Services number for your insurer (typically on the back of your insurance card) and ask a representative the following four questions. Click on each question for more info.
-
This is the most important question. If the answer is yes, go on to the next questions.
-
Your deductible is the dollar amount your plan requires you pay out of pocket before the cost of services is covered. Many plan deductibles are not service-specific, so if you have or will receive other medical services within the calendar year, these may count toward your deductible. As a follow up question, ask “How much of my deductible has been covered this year?”
-
Your coinsurance is what percentage of the cost of each session your insurance company will cover after meeting your deductible. Coinsurance typically covers 50-100% of the cost of sessions, depending on the plan.
-
Your out-of-pocket maximum is the cap on how much you pay for medical services in a calendar year. After this amount is reached, the cost of services for the remaining part of the year should effectively be $0. As a follow up question ask, “How much of my out-of-pocket maximum has been covered this year?”
Using the above information, you and I will determine your per session fee. I maintain a small number of sliding scale fee slots in my practice for those facing a substantial financial barrier.
I don’t have out-of-network benefits—what now?
I offer limited number of insurer-specific in-network slots in my schedule via the Alma Community Network (https://helloalma.com/). This must be coordinated through Alma’s website and will depend on current availability. Sessions scheduled through Alma are conducted solely over the phone.