Out of Network Insurance

Reflect & Journey Counseling is an out-of-network provider, meaning I do not accept insurance and you are responsible for the full payment of each session. As an out-of-network provider, I do provide Superbills upon request. Superbills are receipts of payment which you can submit to your insurance company for reimbursement. I recommend contacting your insurance company to verify if you have out-of-network benefits. When contacting your insurance company, here are several helpful questions to ask:

 

1. Does my policy have out-of-network mental health benefits?

2. What percentage of my fees will you reimburse for an out-of-network provider?

If your insurance company requests the "service code," you can provide them with the following code that applies to the services you are seeking.

  • 90791: Initial Intake Session

  • 90834: Individual Therapy Session

  • 90847: Family Therapy or Couples Therapy Session

  • 90837: Extended Therapy Session (longer than 50 minutes)

3. What is my yearly mental health deductible?

Some insurance companies will reimburse a percentage of your therapy costs after your deductible is met.

4. Is my mental health deductible separate from my medical deductible?

 

5. How much of my deductible have I met this year?

6. Are telehealth services eligible for reimbursement?

 

7. How do I submit a claim for reimbursement?

 

8. How long after I submit a claim will I receive reimbursement?

*Please note that some insurance companies require a mental health diagnosis to verify the need for services. If a diagnosis is required, a formal diagnosis can occur after a diagnostic assessment has been completed. It is unethical for me as your therapist to provide a formal diagnosis prior to this assessment and without full information about your symptoms and history. We will discuss, as relevant, diagnosis(es) as applicable to treatment. 

 

It is within your rights to decline a formal diagnosis.

In compliance with the No Surprises Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing” by providing a Good Faith Estimate.

This Act requires that healthcare providers notify you of your lawful rights to receive a notification when services are rendered by an out-of-network provider, as well as the cost of the services being provided if a client is uninsured, or if a client chooses not to use their insurance.

 

As a healthcare provider, Reflect & Journey Counseling is required to provide you with a Good Faith Estimate for the cost of services. When you schedule your initial appointment you will receive this estimate. You can receive this estimate electronically or in writing. Please retain a copy of your Good Faith Estimate for your records. In choosing to be seen by Reflect & Journey Counseling, you consent to paying the negotiated self-pay rate regardless of your insurance company's out-of-network reimbursement rate. 

For questions and additional information about your rights and the Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.