Therapy in the private practice setting is considered outpatient care and is the lowest level of care for mental health as it is the least intensive level of treatment. Individual psychotherapy sessions occur for up to 60 minutes in an office setting or through a HIPAA compliant Telehealth platform.
Medical necessity for engaging in psychotherapy services is required whether paying out of pocket or using insurance benefits. However, with using insurance benefits, it is important for the client and therapist to clearly identify and document the need for treatment in order to be reimbursed for services or for using your plan benefits.
Medical Necessity is defined within the following parameters for insurance:
A client must meet criteria for a covered mental health diagnosis with symptoms present at time of services. In addition, the individual seeking treatment is experiencing an impact in one or more of the following areas: social, occupational, educational, and/or family role.
It is also important to note that I may not be an ”In-Network” provider under your insurance plan. It is essential that you verify your benefits regularly. In the event that your insurance lapses or you are no longer covered for services, you are responsible for the payment of services. In addition, insurance does not cover late cancellation fees or no show fees and will charged to you through payment on file.
I use a credentialing and billing company called Headway to manage verifying benefits, insurance claims, and copayment/coinsurance For the following insurances: UHC, Oxford, Oscar Health, Aetna, and Cigna.
I will input your information through Headway’s platform and they will contact you through email to set up your account. You will receive the following: a Notice of Privacy Practices, Assignment of Benefits/Financial Responsibility, and Telehealth Consent (please note this is separate from the intake documents you will receive from me as your provider).
In addition to placing your form of payment on Headway’s portal, you’ll need to have a form of payment added before your first session in my EHR system: Simple Practice, as you are financially responsible for sessions should your benefits lapse or change while working together or a late/no show fee is incurred.
Appointment Reminders with the date, time, and cost per session will be sent to you through Headwyas client portal. The payment method on file will be used to charge for each session and you will receive an invoice via email. You can also check your own benefits anytime their their portal.
*Please note that though I am paneled with the above insurance companies, I may be out of network for your plan type. Please ensure you contact your insurance carrier for mental health benefits.
When using OON benefits: client will pay out of pocket for services and seek reimbursement through their insurance provider by submitting a Superbill to their insurance provider. Superbills are used for individuals to receive reimbursement by your insurance provider and may not result in full reimbursement to you.
I am currently registered as an “Out of Network” provider for Blue Shield of California.
You may also be provided a super bill for services at your request if I am not in network with your insurance or credentialed with the insurance company.
I encourage you contact your insurance provider and obtain clarification on your out of network benefits.
As a reminder, please be sure you are checking your insurance benefits regularly to ensure you’re able to use your benefits for services.
I provide a Free 15-Minute Consult to explore your needs and goals for therapy, determine if we are a good fit to work together, while also outlining how to get started with me and schedule your first session.