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Using and Filing Insurance

For all PPO insurance plans except Aetna, I am an out of network provider. This means that you will pay me directly for services and submit paperwork to your insurance company to receive any reimbursement that they may provide. I will provide the necessary paperwork to do this, and your insurance will reimburse you directly.

It is important that you get answers to the following questions from your insurance provider prior to our first session in order to fully understand what your costs will be.

Prior to initial session, please call the number on the back of your insurance card and ask the following questions:

  • Does my plan cover mental health services?

  • What is the rate of reimbursement for an out of network provider (i.e., what is the co-insurance rate)?

  • What is the amount of my out of network deductible?

  • How much remains to meet my deductible for the year? When does it reset?

  • Is pre-authorization needed for mental health services (specifically, for initial evaluation and individual therapy)?

  • Is there a yearly session limit?

Using your PPO insurance benefits with me:

  • Because I only accept Aetna insurance, I do not accept other insurance benefits directly, you will pay the full fee for each session at the time of service.

  • I will provide you with a statement covering the required information that you can submit to your insurance company (a "superbill"). They will then reimburse you directly.

  • You will receive an “Explanation of Benefits” (EOB) from your insurance company each time you submit a superbill.

  • If you remain in treatment until the time that your deductible resets (usually January 1 of each year), you will again need to satisfy your deductible in order to use your insurance benefits.

  • If you are billed for a missed session (session missed or cancelled within 24 hours of appointment), a claim will not be submitted to your insurance as insurance does not pay for missed sessions. You will be personally responsible for the full fee.

This process has worked smoothly for many clients. Please contact me if you have any questions about this information. I am happy to help you get any reimbursement that is available to you.

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