In-network, out-of-network, self-pay, copay, deductible…
It can all be a little confusing. But here are the answers to the questions that people often ask about insurance and fees.
Q: What Insurances do you work with?
I am "in-network" for the following insurances:
- Blue Cross Blue Shield of Michigan
- ASR/Physicians Care.
(Currently I am not in-network for Priority Health, Blue Care Network, Medicare, or Medicaid.)
If you have one of the insurances I am in-network with, you are required to pay your co-pay at the time of service, assuming your deductible has been met. I will then I file the claim directly with your insurance company (electronically) and they will send reimbursement directly to my office.
With any given insurance company, I am obligated to accept their fee schedule as part of the contract I have with them. (Fee schedules vary across insurance companies.)
Q: What if my insurance is not one you accept?
You may still be eligible for "Out-of-Nework" benefits.
This means your insurance company may provide reimbursement for sessions but at a reduced rate.
However, I do not bill the insurance companies for out-of-network benefits. You pay for sessions out-of-pocket, and then I provide a receipt that has the required information on it, which you can then submit to your insurance carrier for reimbursement directly to you.
Q: How much does therapy cost?
If I am "In-Network" with an insurance company, I am obligated to accept their reimbursement rates.
If I am "Out-of-Network," or a client is self-pay, the fee for the initial session is $160 for the first session (Initial Assessment) and between $130 and $150 for subsequent sessions. I realize this is confusing, but therapists follow what are known as procedure codes to bill services. Each code can have a slightly different reimbursement rate.
A detailed fee schedule is provided with the initial paperwork.
Q: I don't understand insurance terms like deductible, copay, and/or coinsurance. Can you explain them?
A deductible is the amount of out-of-pocket expense you pay before your insurances kicks in. Deductibles vary across insurance carriers, and sometimes they vary from year-to-year with the same carrier. Your deductible depends a lot on what your employer has to offer. (Note: please check with your carrier to determine the amount of deductible and whether it has been met.)
A copay is the amount you pay to an "in-network" provider after your deductible has been met. Usually it is somewhere between $10 and $30, and frequently the amount can be found on the front of your insurance card. If I am in-network for your insurance, and your deductible has been met, you only pay your copay at the time of service. I take care of the rest.
A coinsurance is like a copay but instead of being a flat amount it is based on a percentage of the fee. Usually copays are a better deal because they are fixed. Coinsurances will obviously vary.
Q: Can you bill me at the end of the month?
Sorry, no. Fees, regardless of type, are collected at the time of service. Accepted forms of payment are cash, check, credit card, and HSA card.