INSURANCE

Frequently Asked Questions

1. Do you take insurance?

YES.

A unique benefit of my practice is that I communicate directly with your insurance provider, so that you don't have to. This is very different from most other practices. Some of the administrative work that I do on your behalf include:

- filing all claims

- verifying your exact insurance benefits before we start so we can minimize surprises down the road

- following up with insurance if there are any problems or questions.

2. Are you considered an in-network or out-of-network provider?

It depends on the plan. I communicate directly with insurance for both in-network and out-of-network plans, however, so your experience does not greatly differ. This means that you get to focus on just taking care of you, and I take care of the rest. This is very different from most other practices, where clients are required to deal with insurance themselves.

3. How does payment work?

I collect the majority of the fee from your insurance provider directly. This is different from other practices, where you are often required to pay the full fee upfront and seek reimbursement from your insurance on your own.

Clients' portion of the fee per session are typically $20-50, which is collected either at the time of the session or at the end of the month.

4. Is it better to work with an in-network or out-of-network provider?

Like with most things in life, there are advantages and disadvantages to working with an in-network or out-of-network provider. Every insurance plan is truly different so it is hard to generalize across all plans, but below is a chart that offers some comparisons between seeing an in-network or out-of-network provider.

In-Network Out-of-Network
Cost
Your responsibility is typically $20-40 per visit, after the deductible is met. Your responsibility is typically $30-50 per visit, after the deductible is met.
Convenience
I file claims directly to insurance for the majority of the payment, and collect your portion of the fee from you, either the co-payment or co-insurance. I file claims directly to insurance for the majority of the payment, and collect your portion of the fee from you, either the co-payment or co-insurance. Because of the unique benefits I offer in my practice, there is virtually no difference in convenience between in-network or out-of-network.
Confidentiality
Certain insurance plans require providers to submit extensive, confidential information, including intake information, progress notes, and treatment plans before insurance will approve services or after a specified number of sessions. Very little information is communicated to insurance - typically only the name, date of birth, date and length of session, and a diagnosis code.
Freedom of Choice
Many in-network providers in DC are full so you may have fewer choices with whom you’d like to work - and sometimes, only 1 or 2 providers who have openings at all You have more choices and freedom to select a provider who you feel is a good fit for you based on location, gender, specialty areas, counseling approach, and personality or style. Having a good fit with your therapist is one of the best predictors of positive outcomes in therapy.
Flexibility
Some insurance plans place restrictions on the session length or number of sessions for in-network providers. We have the freedom to decide on the session length that works best, with many clients preferring to meet for longer sessions. We also have the freedom to decide when we want to end counseling. It is all up to us, and only us.

5. Do you offer reduced fees or a sliding scale?

YES. I feel it is important that counseling be available to as many people as possible, no matter their financial circumstances. I am open to sliding or reducing fees depending upon one's financial situation. Please contact me if you need a reduced fee.

6. Insurance jargon is confusing to me. Can you help me understand what all these terms mean?

Here is a chart with definitions of common terms you are likely to find in your policy:

Deductible

The amount you pay for health care services before your health insurance begins to pay. For example, if your deductible is $1,500, you would pay 100 percent of your health care charges until the amount you paid reaches $1,500. After that, some services you receive may be covered at 100 percent, or you may have to pay coinsurance.

Co-Insurance

Your share of the costs of a health care service. It’s usually figured as a percentage of the total charge for the service. Say you’ve already paid out (or met) your $1,500 deductible and your coinsurance is 20 percent. For a $100 health care bill, you would pay $20 and your insurance company would pay $80.

Co-Payment

A fixed amount you pay at the time you receive the service. For counseling sessions, this is typically $20-30. Generally, your plan requires either co-insurance or a co-payment, not both.

Allowed Amount

The amount insurance deems is a reasonable charge for a particular service. Anything above this amount would not be covered by insurance. The allowed amount varies across all insurance plans. It is often based on what the "usual and customary rate" is for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. My fees are considered “usual and customary” for the DC area.

In-Network

Working with a provider who is contracted with a specific insurance to be a preferred provider in their network.

Out-of-Network

Working with a provider who is NOT a preferred provider within the network and is not contracted with insurance.

Out of Pocket Maximum

The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered necessary health benefits. This limit must include deductibles, coinsurance and/or copayments. For example, if your out-of-pocket maximum is $3,000, insurance will pay 100% of covered services after you’ve paid $3,000 for the benefit year.


If you have other questions, please feel free to contact me.