Figuring it all out?

You may be responsible for a co-pay. It can be paid by cash, check, credit card. 

Claims submitted directly by secure electronic format to the insurance company for reimbursement. Note: Insurance companies always add the disclaimer that filing a claim DOES NOT guarantee payment for services rendered- even if you have paid your copay. 

The insurance company will reimburse your provider for what they believe is their value of the appointment. The co-pay remains in your balance unless you have already paid. It can be paid in your portal or in person. Any difference will have to be written off as a business loss (per the contract). [Insurances use a formula for reimbursements. If we "charge" $125 for a session, they don't PAY that- they pay a percentage. Therefore, if I lower my rates, they lower their reimbursement.] 

This means the provider has sent in an application to the insurance company to be accepted as an "in network" provider with the insurance company but has not yet received approval. They can reject my application for various reason (e.g. "not hiring" due to too many providers, this provider is negotiating reimbursement fees, etc.) 

Call the "Behavioral Health" number on the back of your card to check on the status of this provider. Until approved, this provider can give you Superbills for your sessions. 

Superbills are "invoices" that include all the information required by insurances in order to pay for a session. You will pay for your session at time of services. You can submit this directly to your insurance company to seek reimbursement. This will be impacted by any copays, deductibles, etc. on your policy. Again, you can call the "Behavioral Health" number on the back of your card for more information. I cannot get this information for you.  

Yes. If you are the first person with that insurance, I will have to apply. It can take months to get credentialed or paneled with an insurance company. Superbills will be provided until then. Some companies do not reimburse well, they may not be appealing to work with, or they may not have openings for another provider right now- (e.g. they are not "hiring"). There are some insurances that WILL NOT allow a provider to see clients who are not in network.

Yes. However, there are some insurances that WILL NOT allow an out of network provider to see their clients anymore. There used to be a reduced reimbursement rate for this. Providers could choose to accept this reduced rate. Now, there is just refusal of authorization due to having other contracted providers in the area- even if you verbalize wanting to switch providers and the provider wants to accept that reduced rate. The answer? Keep or find another in network provider. Or, private pay. 

It is a long process which takes lots of paperwork. Once that paperwork is done, providers have to make sure online information is up to date (e.g. insurance certificates) or it can delay the process; even make the process have to start over. Read more here about the whole process https://blog.therapynotes.com/getting-on-insurance-panels-how-to-navigate-the-process

You can ask to pay for sessions out of pocket and keep your information (more) private. It will not be sent to your insurance at all - if that is a concern. Session is paid for at time of service by check, cash, or credit card. Individual sessions are $135 per 50 minutes. There is a one-time intake at $150 per intake and takes 90 minutes for one session; depending on if you do electronic assessments ahead of time (saves a lot of time) and if you have a complex history. 

There is a federal income sliding scale that is used to determine a lower rate. You can use the application to determine if you fall within that sliding scale and at what rate. 

Superbills are "invoices" that include all the information required by insurances (including diagnosis code) in order to pay for a session. You can submit this directly to your insurance company to seek reimbursement. This will be impacted by any copays, deductibles, etc. on your policy. Again, you can call the "Behavioral Health" number on the back of your card for more information. I cannot get this information for you.  

Yes. After three years of taking insurance HATS Counseling, LLC will no longer accept insurance or file insurance claims. Superbills will be made available for clients to submit for reimbursement directly to their insurance. Please see the No Surprise Act policy posted on this web site also. 

Yes. But that is illegal. Everything is regulated. It is a government healthcare system even though I am a private practice. Please be patient. This is not "Doc Hollywood" as much as I would like it to be (Caton-Jones, M.(Director).(1991). Doc Hollywood. [Film]. Warner Brothers.) That is fiction and idealistic, utopian artistic nostalgia. Yes, Brene Brown, nostalgia. (Brown, B. (2021). Atlas of the Heart; Mapping Meaningful Connection and the Language of Human Connection. Random House Books.) We

Your insurance may determine a "session" is only 30-45 minutes. If your therapist bills for a 90837 (60 minutes), they will sometimes not get reimbursed at all unless they catch this. Hmmm. So- If you are prepaying privately, AND If your Superbill says this code (90837), you may want to ask your insurance company if that is the issue if you are not getting reimbursed. We can start scheduling 90834's (30-minute session).