FAQs About Insurance
Deciphering your insurance plan and benefits can be confusing and overwhelming — we’re here to help provide guidance and support!
Please keep in mind that the information here are general answers to frequently asked questions. It's important to note that your specific insurance plan may have different policies and coverage details. To ensure accuracy and clarity regarding your individual benefits, we recommend contacting your insurance provider directly.
-
No, we are an out-of-network provider, which means we do not accept any insurance. However, your insurance plan may offer coverage/reimbursement for out-of-network mental health services.
Medicaid/Medicare do not offer any reimbursement/coverage for our services. You will have to pay out-of-pocket.
-
You can call your insurance company using the member services number on the back of your insurance card. Request to speak to a representative and ask if your plan has any out-of-network mental health benefits. There may be an automated service that explains your benefits but this typically represents your benefits for in-network providers, which does not apply to us.
-
We would be happy to call your insurance company to check your benefits and coverage.
You can also call your insurance company yourself before booking an appointment to get a sense of your eligibility and coverage. We can call again to double check the details once you have booked your intake session.
-
Your deductible is the amount you must pay out-of-pocket for healthcare services before your insurance will reimburse.
For example: if your deductible is $2,000, you must pay $2,000 out-of-pocket for healthcare services first. After that, your insurance will help cover expenses.
In other words, you will not be reimbursed for services if you have not reached/fulfilled your deductible.
The good news is that, if you haven’t reached your deductible, your payments for our services may count towards fulfilling that amount. The sooner you fulfill your deductible, the sooner you may have treatment sessions reimbursed.
-
You will be charged the full cost of our services and be reimbursed by your insurance afterwards, if eligible.
We will provide a superbill for you to submit to your insurance company to claim reimbursement. Many insurance companies offer the option to do this online.
Your insurance company may take weeks or months to process your claim and issue a reimbursement.
-
Please note that reimbursement is not guaranteed and we/you will not know for certain the amount you will be reimbursed (if eligible) until your claim is processed by your insurance. Below is general information that may or may not apply to you and your insurance plan.
Usually, insurance will reimburse a certain percentage of the allowed amount for each service. The reimbursement rate will vary based on your insurance plan. From our experience, clients typically receive a reimbursement rate of 50%-70%. Keep in mind that this rate is applied to the allowed amount set by your insurance.
What is the allowed amount? The allowed amount is the price your insurance sets for each service. More often than not, the allowed amount set by your insurance is lower than our pricing. For instance, we may charge $200 for a psychotherapy session but your insurance may decide that the usual and customary fee for a session should be $100.
AN EXAMPLE: One session is $200 and we will charge you $200 after your session. You submit your superbill and your insurance agrees to reimburse you 50% of their allowed amount ($100). This means you will be reimbursed 50% of $100 as in you will get $50 back, NOT 50% of $200.
-
Insurance companies may refuse to cover our services/reimburse you and suggest that you find an in-network provider instead.
In certain cases, we may be able to appeal and negotiate a single case agreement. However, we would have to provide compelling reasons why you need our care specifically and cannot see an in-network provider.
Because this is a lengthy process, we will only explore this option if you plan on receiving treatment with us for a long period of time. Please call us and we can discuss this in more detail or find a way to make our services more accessible to you.
-
Pricing varies for different services/treatments. Please give us a call at 212-877-2130 and let us know which service you’re interested in so we can provide pricing info.
Our general payment policy is that you are responsible for the full cost of services, even if you have out-of-network mental health benefits. After payment, we can send you a superbill for you to submit to your insurance company for reimbursement claims.