Each insurance company has different rates that they reimburse for different types of services, represented by specific billing codes (or CPT codes). To make things more difficult, some services aren’t covered at all which is why it’s important for you as the client to contact your insurance company before scheduling services to make sure there won’t be any surprise bills.
When verifying your benefits with your insurance company please inquire about the following codes, as these are the codes we use most often:
- 90791 (assessment) usually the first 1-2 sessions to complete a mental health assessment
- 90834 (45 minute individual session) individual sessions 38-52 minutes long 90837 (60 minute individual session) individual sessions 53+ minutes long
- 90847 (family therapy with client present) Used for family therapy and couples therapy (when covered by insurance) 26+ minutes
- 90846 (family therapy without client) sessions with a family member without the identified client present (typically this is billed for parent only sessions where the child is not present) 26+ minutes
The two family therapy codes (90847 and 90846) are the most common ones that aren’t covered by insurance. They are also the most common reason why you might see different rates listed when you have coinsurance or a deductible. Please confirm with your insurance before scheduling these sessions whether or not these codes are covered. If they are not, and you need financial assistance paying for them out of pocket, please contact us ahead of time and we will work with you on sliding scale fees as needed.
Your EOB:
When you receive your explanation of benefits (EOB), these can be confusing to understand. When we bill insurance, we charge our full rate (typically $200), however, this is not the rate we receive from insurance . We bill insurance the full amount, they tell us what the “allowed amount” is (our contracted rate), what insurance pays, and what the patient is expected to pay. The rest is called an “exceeds allowable” amount – this is the amount that we do not get paid. So for example, we might charge an insurance company $200 for our services. The EOB might break it down like this:
- Charges: $200
- Allowed amount: $140
- Amount paid: $120
- Patient responsibility: $20
If you see an invoice in your account for $200, please don’t panic! You will not owe $200/session if your insurance does not pay. For clients without insurance coverage, we offer a cash pay/time of service discount since we do not have to spend the time and resources billing and collecting from insurance. This discount brings the out of pocket rate to $125-150 (depending on the provider). This will be the out of pocket rate you are working with, and we can offer sliding scale rates or payment plans if needed, particularly when charges were unexpected.