Referrals, Insurance, Payments, Oh my!

FAQ:

Q: Do I need a referral to see someone at your clinic?

A: Usually not! Many clients self-refer. If your insurance does require a referral, we’ll help you figure that out.

However, for new testing and medication patients, we do require a referral and/or past records for the provider to review before the first session.

Q: How do I know if my insurance covers therapy?

A: Most do.

To ensure, call the number on the back of your insurance card and ask,

“Does my plan include outpatient mental health benefits?”

“Are my benefits through you, or through a separate behavioral health company?”

“Does my plan limit how many mental health sessions I may have per year? If so, what is the limit?”

Q: How do I know how much my insurance will cover for mental health services?

A: Call the number on the back of your insurance card and ask,

“Do I have a deductible? If so, what is it and have I met it yet?”

[Deductible = total amount the patient must pay each year before insurance begins paying. Once met, services are covered at a much higher (but not necessarily 100%) rate.]

“What is my copay or coinsurance for outpatient [therapy, testing, medications, etc.]?”

[Co-pay = flat fee paid at each visit even before insurance processes.]

Q: What if I have a high deductible plan?

A: A high deductible plan means you are responsible for paying a larger amount out of pocket before your insurance begins paying for most services.

For example, if your deductible is $3,000 and you have paid $500 so far, you may be responsible for all visit costs until that $3,000 is met.

In practical terms, this means you will pay more at the beginning of the year, but costs often decrease (sometimes entirely) later in the year after the deductible is met.

To prepare,

check your deductible status
ask about your coinsurance percentage (how much you will owe, if any, after the deductible is met)
know your out-of-pocket maximum (yearly spending cap)
set aside funds in an HSA/FSA if available
ask our office for a cost estimate before starting

Remember, even with good estimates, final costs are determined by your insurance after the claim is processed.

Q: What if I don't have insurance?

A: No problem. We offer a self-pay discount for those without insurance or for those who elect not to use their insurance.

Q: What if you don't accept my insurance?

A: “Out-of-network” means we do not have a contract with your insurance company.

If we are out-of-network with your insurance provider, your options are to:

Self-Pay at our discounted rates. This is the clearest, most straightforward option.
Use Out-of-Network benefits, if you have them. This means you pay for the visit upfront and we provide a superbill (detailed receipt with billing codes) that you provide to your insurance company for reimbursement. Even if your insurance company does not reimbursement much (or any) of the costs, you may still be able to apply your payments to your out-of-network deductible and out-of-pocket maximum for the year.

If you’re considering out-of-network care, call the number on the back of your insurance card and ask,

“Do I have out-of-network mental health benefits?”
“What is my out-of-network deductible?”
“What percentage do you reimburse (coinsurance)?”
“What is the allowed amount for [therapy, medication, testing] services?”
“Does this count toward my out-of-pocket maximum?”

Q: Can I come in just to get a diagnosis?

A: Yes! We offer specialized diagnostic assessment/testing for kids, teens, and adults.

Q: I’m not sure what kind of help I need. What should I do?

A: No worries – we get it. For an idea of what we offer, browse the Staff and Services page of this website or give us a call at 701-323-0924 and we’ll help match you with the right provider or service.