Sessions are typically 50 minutes. The standard rate for a 50 minute session is $160 for the initial assessment and $150 for following sessions.
Insurance and Reduced Fee:
We do everything we can to accommodate clients being able to use health insurance for mental health services. The process for clinicians to become in-network with insurance companies is tedious and time consuming. Some insurance companies will not allow therapists who are being supervised (LGSWs/LMSW, LGPCs) to bill for therapy services. All insurance companies allow fully licensed therapists(LCSW-Cs, LCPCs) to apply to become in-network. All of our clinicians are in-network with Cigna, CareFirst and the Blue Cross insurances or in the process of becoming in-network. During the intake call, our administrator will be able to discuss the insurance process for your particular plan. If the clinician you will be working with is a LGSW/LMSW or LGPG, we offer a reduced rate for sessions. Providing accessible and affordable mental health care to individuals seeking support is our priority at PCCC.
We also accept Health Savings Accounts as a form of payment.
It is your responsibility to know what your copay, deductible or out of pocket amounts may be. You are expected to pay for service at the time treatment is provided. Client are responsible for balances due.
Clients have access to a portal which allows online payments.
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my deductible and has it been met?
- How many sessions per year does my health insurance cover?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
Reduced fee services are available on a limited basis.
Cash, check and all major credit cards accepted for payment. Clients have access to an online portal for online payment options.
Cancellation and Missed Appointment Policy
If you do not show up for your scheduled therapy appointment, and you have not notified us at least 48 hours in advance, you will be charged $75 for the missed session. Insurance will not cover missed appointments. We ask you for credit card information to keep on file for the purpose of billing for missed or cancelled appointments as well as balances due. Future appointments will not be scheduled until balances are up to date. If you miss two consecutive appointments without notifying your therapist at least 48 hours in advance, we will assume you want to discontinue treatment and we will close your file.
Submission of Claims to Insurance
As a courtesy to our clients, we will submit the claim to your insurance company. Please be aware that our contractual relationship is with you, our client, and not with your insurance company. It is your responsibility to ensure that your health insurance coverage includes mental health care. You will be responsible for payment in full if insurance does not cover the services provided.
Request a therapy appointment online here.
Questions? Please contact me for further information.
NO SURPRISES ACT Explained in layman terms…
In December 2020, Congress passed the No Surprises Act. It was mainly intended to reduce unexpected medical bills for patients who were anticipating surgical procedures or had emergency procedures. The need for the law came out of unexpected bills from providers who were not in network with a patient’s insurance. This law went into effect January 1, 2022. Though the intent of the law may not have been to include mental health providers into the term “providers”, private practice therapists have found themselves being held to the same requirements as medical doctors. Professional associations were not able to provide guidance or advice prior to the implementation of the Act. Most mental health providers only became aware of the impending law through networking with colleagues. The basics of the requirements are already in place for most private practice therapists, as our professional associations have strong ethical standards requiring us to:
- Inform clients of fees before commencing treatment.
- Make it clear that, if a client has insurance, they have the option to seek a provider within their network
- Allow clients who choose to work with someone out-of-network to receive a “superbill” which can be submitted for possible partial reimbursement, depending on the policies of the individual’s plan. Superbills contain diagnostic codes, another requirement of this new bill.
Additional requirements of this new legislation in theory do not apply to mental health services. According to this law, mental health providers are directed to determine a diagnosis before beginning therapy. This requirement is in direct contradiction with the ethical standards of our profession, prohibiting diagnosis of a client prior to an intake and assessment. This law also requires therapists to provide a Good Faith Estimate (GFE) predicting the total fees for services rendered, before therapy even begins. This requirement makes sense for a surgical procedure but cannot be applied to psychotherapy. A therapist cannot presume to know a client’s diagnosis, how many sessions will be needed based on a diagnosis, or if additional support systems and interventions could be required for the client’s mental health needs. Therapists develop a treatment plan with goals for a client once therapy begins. The clinician may not be aware of underlying concerns that could require extended therapy services.
Positive Changes Counseling Center (PCCC) offers clients the benefit of utilizing health insurance. Currently, this law does not apply to clients who use health insurance. This law only applies to clients who do not use insurance or are working with a clinician who is out of network with their insurance. For clients with insurance, therapy sessions are submitted to their insurance for payment. Clients’ financial responsibility is limited to the amount insurance does not cover, typically a copayment or their deductible.
There are contradictory interpretations of several aspects of the No Surprises Act and conflicting information regarding the obligations required by the provider.
There are already challenges to the inclusion of mental health providers in the way this legislation was intended. Nevertheless, the following will be offered to clients who are paying out of pocket or working with a therapist who is not in-network with their insurance:
- A form which names the health insurance the client has presented; acknowledgement that the therapist the client is receiving therapy from is not in network with the client’s insurance, and client has chosen to continue under that therapist’s care. Client will be provided with names of therapists who are in network with their insurance if requested.
- A Good Faith Estimate. This form includes the clinician’s identifying information, including National Provider Identification number; client’s diagnosis; the number of sessions required; cost for sessions. Clients will be asked to sign and return a signed copy of the GFE. Included will also be the client’s right to appeal a fee and the procedure to appeal. Please keep in mind that this form is required by the law, and is not applicable in our setting, but necessary per the law’s requirements.
- For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
I hope this information has been helpful. I will continue to update the information and requirements as I become informed of changes. My goal has always been to provide extraordinary mental health services to individuals seeking support. I am aware my private practice is one of the few therapy practices that continues to accept insurance. Every clinician and staff member who is part of the PCCC community joins me in the commitment to provide support and individualized attention to every client under our care. Please feel free to contact me through email ([email protected]) should you have any questions.
Debbie Disney, LCSW-C
Founder, Positive Changes Counseling Center