Self-pay:
There are many benefits to self-pay vs. insurance:
1.) No diagnosis is required for self-pay clients. While a diagnosis for some can be beneficial, for others it could have its consequences. It could compromise one’s ability to obtain life, health, or disability insurance.
2.) Your goals and treatment will be determined by you and the clinician as a self-pay client. When going through insurance, our choices and treatment options may be limited as insurance determines for us what is considered “medically necessary” and could deny a certain diagnosis, number and length of sessions, and treatments.
3.) No limits placed on treatment. Due to insurance guidelines, limitations are often placed on your therapy process including, but not limited to, how many total sessions you receive, how many sessions per week, or even how long of session you may have. This does not always align with your treatment recommendations and inhibits your progress.
4.) You will have complete privacy. When using insurance, your information (diagnosis, nature of issues seeking counseling, treatment goals, how long the issue has persisted) is all shared with your insurance, anyone involved in processing and handling the claims, and future employers.
Out-Of-Network Reimbursement & Superbills
In addition to using your HSA/FSA account to pay for your therapy process, another option to make self-pay more doable is Out-Of-Network (OON) reimbursement.
My practice will provide Superbills upon request so that you may submit for OON reimbursement.
What is a Superbill? A Superbill is a receipt that contains my business and tax information, as well as your session and billing information.
Many insurance plans have OON benefits. If yours does, you may submit this Superbill to your insurance to see if OON reimbursement is a possibility.
NOTE: Not every insurance plan has OON benefits. Please verify with your insurance.
NOTE: Your Superbill will contain a diagnosis. If you are requesting self-pay in order to avoid a diagnosis on your record, then you may not want to request a Superbill.
Rates
Initial Assessment/Evaluation: $200 per session.
Consultation or Individual psychotherapy: $ 175 per session.
EMDR intensive: 3 hour session: $525. Typically not covered by insurance.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate or visit www.cms.gov/nosurprises.