Billing and Fees for Therapy
INSURANCE: Depending on your policy and insurer you may be eligible for reimbursement for some or all of my fee. I am considered out of network with all insurance carriers. What this means is that you will pay for your appointment at the time of service and that per your request you will be furnished with a superbill through your Simple Practice portal. The superbill can then be submitted directly to your insurance company for possible reimbursement.
While I don't accept insurance, I do work with Mentaya, a platform that helps clients get money back on out-of-network therapy sessions. If you have out-of-network benefits, Mentaya will file claims and handle the insurance paperwork to make sure you get reimbursed. They charge a 5% fee per claim and have helped people get thousands of dollars back per year. You can sign up using this link: https://mentaya.com/inviteclient/3gimKAdchpvHJZ2ZziTR Note: Mentaya's goal is to save you time and money. It's completely optional, and as your therapist I do not benefit in any way from your participation.
Couples Therapy and Reimbursement: The amount of insurance coverage for couples counseling varies greatly. It is best to check directly with your insurance company. To check your coverage you would ask if they cover couples counseling, procedure code 90847 with diagnosis Z63.0 (Problems in relationship with spouse or partner). If you are told that the procedure needs to be medically necessary, they will not cover Z code diagnosis.
In order to file for insurance you must have a diagnosis. This diagnosis becomes part of your permanent record. Please feel free to discuss this with me - I want to support you in making a choice that feels right for you.
My current fees are $160 for a 50-minute individual or couple session and $240 for an 80-minute couple session.
Good Faith Estimate
Under the No Surprises Act (H.R. 133 - which will go into effect on January 1, 2022), health care providers need to give clients or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
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This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.
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You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes (under the law/when applicable) related costs like medical tests, prescription drugs, equipment, and hospital fees.
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The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
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If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
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Make sure your health care provider gives you a Good Faith Estimate within the following timeframes:If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; orIf the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.
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The No Surprises Act has a universal waiver form required — McGovern Therapy PLLC has adapted into an identical online form. Ask your provider for a good faith waiver.
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This is the public disclosure of the “Good Faith Estimate”
Note: A Good Faith Estimate is for your awareness only. It does NOT involve you needing to make any type of commitment.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 800-985-3059. Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.