As a provider for various insurance companies, I agree to accept the contract rates for different plans. It is important that you call your insurance company prior to initiating services to understand what is covered and how much of a deductible you have with your plan. As insurance is changing, there can be higher out of pocket expenses, and it is good to understand this at the beginning of therapy.
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, my billing service and I will assist you to the extent possible in filing claims and ascertaining information about your coverage, but you are responsible for knowing your coverage and for letting me know if/when your coverage changes.
Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. Managed Health Care plans such as HMOs and PPOs often require advance authorization, without which they may refuse to provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. Some managed-care plans will not allow me to provide services to you once your benefits end. If this is the case, I will do my best to find another provider who will help you continue your psychotherapy.
You should also be aware that most insurance companies require you to authorize me to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe the nature of your problems and whether they are short-term or long-term problems. All diagnoses come from a book entitled the DSM-V. There is a copy in my office and I will be glad to let you see it to learn more about your diagnosis, if applicable.). Sometimes I have to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands.
In addition, if you plan to use your insurance, authorization from the insurance company may be required before they will cover therapy fees. If you did not obtain authorization and it is required, you may be responsible for full payment of the fee. Many policies leave a percentage of the fee ( which is called co-insurance ) or a flat dollar amount ( referred to as a co-payment ) to be covered by the patient. Either amount is to be paid at the time of the visit by check or cash. In addition, some insurance companies also have a deductible, which is an out-of-pocket amount, that must be paid by the patient before the insurance companies are willing to begin paying any amount for services. This will typically mean that you will be responsible to pay for initial sessions with me until your deductible has been met; the deductible amount may also need to be met at the start of each calendar year. Once we have all of the information about your insurance coverage, we will discuss what we can reasonably expect to accomplish with the benefits that are available and what will happen if coverage ends before you feel ready to end your sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above, unless prohibited by my provider contract.
If I am not a participating provider for your insurance plan, I will supply you with a receipt of payment for services, which you can submit to your insurance company for reimbursement. Please note that not all insurance companies reimburse for out-of-network providers. Also, I find that many people choose not to bill their insurance for many reasons like a high deductible. If you prefer to use a participating provider, I will refer you to a colleague.
If you are not using insurance, your fee would be $160 for an initial assessment (first session which is usually about 60 minutes) and $145 for individual sessions after this (which are usually 45-50 minutes). Group sessions are $55 per group. If you have a financial hardship I am happy to discuss payment options with you on a case by case basis. If you have any questions about payment please do not hesitate to discuss this with me. I generally discourage people from bringing their psychotherapy treatment into court proceedings. My fees for court proceedings are detailed in my consent agreement.
Insurance I currently accept:
Anthem Blue Cross Blue Shield
Maine Community Health Options
Out of Nework
If we are working together in treatment, I will reserve times for you on a weekly or other basis as is needed. Since I have this time reserved for you, I cannot schedule anything else in it. I require patients to give me 24 hours notice of the need to cancel or change an appointment. Exceptions to this policy include urgent medical situations, weather or some personal emergency. I will provide you with the same level of notice of canceling appointments except under the most urgent conditions (which are rare events). If you cancel an appointment late without urgent reasons as noted above or if you do not show, you will be charged for that appointment. This fee is not your co-pay but is the session fee based on your insurance policy, but it will be billed directly to you. I do not wish to be charging my patients these fees and I work with each of them to ensure that we communicate effectively about our appointments. However, I have set aside professional time and I cannot use this at the last minute for another client.