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Blue Mountains
Blue Mountains

Fees & Health Insurance

How a Fee is determined with a client:

The fee charged for psychotherapy is an extremely important issue. Specific plans and arrangements regarding fees will be discussed during our initial consultations. 

I am a Medicare provider.  If Medicare is your primary coverage I will submit claims directly to Medicare.  If you are also covered by a secondary insurer for your "Part B" claims, Medicare will ordinarily forward the claim on to that secondary payor for their consideration. 

Health Insurance Plans  and Psychotherapy

Every insurance company has different terms of coverage and even different plans within the same company have different terms of coverage.  I am unable to answer questions about specific terms of an individual's coverage.  A phone call to your insurance company can help determine the particular mental health coverage provided by your plan.  When you do contact your health insurance company, ask the following questions:

  • What are my outpatient mental health benefits?
  • Do I have "out-of-network" benefits?
  • What is my annual deductible and has it been met yet this year?
  • What is my "out-of-pocket" limit, if any?
  • What is the coverage amount per therapy session?
  • How many therapy sessions does my plan cover?  Is there an annual cap on the number of sessions I may use during the calendar year?
  • Is there an annual cap on the amount of money available to me to help pay for sessions?
  • Is there a lifetime cap on my mental health benefit?
  • Will a "managed care" company be involved in managing my therapy? If so, will my therapist be asked to provide treatment plans and summaries to that managed care company or "care manager?"
  • Is pre-certification required and/or am I required to get a referral from my primary care physician?

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