Insurance

“Out of network" simply means that we do not have a contract with your insurance company. However, insurance companies are aware that they do not work with every therapist and that their in-network database may not meet the demand for therapy. This means they may not have enough therapists with available appointments to accommodate everyone. Therapists who are contracted with insurance companies and operate as "in-network" providers often have a larger caseload, leading to less individualized attention for each patient and longer wait times, ultimately resulting in a slower healing process. If you are not sure whether your insurance company has out of network benefits, contact us today to find out!

Reach out to us to verify your out of network benefits! If you wish to verify your out of network benefits on your own, just call the members services line on the back of your insurance card and ask: 

Do I have out of network mental health benefits for outpatient services?

Does it cover procedure codes 90791 (initial therapy assessment) and 90837 (ongoing therapy sessions)?

If yes, do I have an out of network deductible? If so, what is my deductible and have I met my deductible yet? If not, how much of my deductible is left?

Do I have a copayment or coinsurance after that? If so, what is it?

Do I need a prior authorization for this service to be reimbursed?

The initial assessment is more of an involved process. During the initial session, we gain a comprehensive understanding of your presenting concerns and how they affect different aspects of your life. With this knowledge, we develop a personalized treatment plan tailored to your specific needs and goals.

Subsequent sessions will focus on working towards your therapeutic goals. Our approach involves exploring your patterns of thinking, feeling, and behavior to develop greater insight, while equipping you with the necessary tools to achieve your desired outcomes.

We take all major credit/debit cards, FSA/HSA cards, cash and checks.

At MindWell Behavioral Health, we believe in fee transparency – the cost of therapy without any health insurance is typically $100 or $150 per session, varying depending if it is an initial evaluation or follow-up sessions.

However, many people do have out of network benefits weaved into their insurance plans without their knowledge. Depending on your plan and healthcare spending, your insurance company will reimburse you for your sessions. Usually, insurance companies cover a percentage of your "out of network" costs after you reach your deductible, which is the amount you're expected to pay out of pocket before insurance starts making payments as per the contract. The specific deductible and reimbursement percentage vary from person to person and plan to plan, but generally, insurances reimburse 60%-80% of their reasonable and customary rate after meeting the deductible. It's possible that you've already met your deductible through other healthcare expenses!

Reach out today to check your health insurance benefits!

     We strive to make quality care affordable and transparent, ensuring our patients avoid unexpected bills. To do this, we accept a wide range of insurance plans. However, the cost of your visit depends on several factors related to your specific insurance coverage. While we do our best to provide accurate estimates, the most reliable way to determine your visit cost is by contacting your insurance provider directly.

What is a Deductible?

     A deductible is the amount you must pay out-of-pocket before your insurance begins covering medical expenses. This amount is determined by your insurer and typically resets annually.

     Example:

Martin has a health plan with a $450 deductible. Each doctor visit costs $150. Martin will pay the full cost for the first three visits, covering the $450 deductible. Once met, Martin’s insurance will start contributing to future medical expenses, either covering the full cost or requiring a copay or coinsurance payment, depending on the plan.

What is a Copay?

A copay is a fixed fee you pay for each visit, set by your insurance provider. You can often find this amount on your insurance card. Note that many plans classify psychiatrists as specialists, which may have different copay amounts.

     Example:

If your copay is $20 and your deductible has already been met, you will pay $20 per visit to a specialist, regardless of the total service cost.

What is Coinsurance?

Coinsurance means you share the cost of care with your insurer. Instead of a flat fee, you pay a percentage of the total cost, while your insurance covers the rest.

     Example:

If your plan includes 20% coinsurance and you have already met your deductible, you will pay 20% of the visit cost, while your insurer covers the remaining 80%.

How is My Visit Cost Determined?

     Like most healthcare providers, we submit claims to your insurance provider before sending you a statement. Your insurer determines your out-of-pocket costs through the following process:

• You receive care.
• We submit a claim to your insurer.
• Your insurer reviews the claim and checks your plan details.
• They calculate your out-of-pocket cost based on your coverage.
• We receive the insurer’s determination and bill you accordingly.
• You receive a statement with the final cost.

Since insurance processing times vary, it may take a week or longer to receive your bill.