Understanding Therapy & Insurance

In-Network Insurance Plans I Accept

Knowing whether I’m in-network with your plan is the first step. If I’m in-network, I’ll bill your insurance directly and you’ll only owe whatever your plan doesn’t cover (like copays, coinsurance, or unmet deductibles).

I am currently in network with the following insurance providers for clients located in Kansas:

• Blue Cross Blue Shield (BCBS) / Anthem (even those BCBS plans based outside of KS)

  • Some BCBS plans outsource their mental health benefits to United Healthcare Commercial plans that I am NOT in network with… but this is rare! I’ve only seen it once.

• Quest Behavioral Health

• Ambetter by Sunflower

• ProviDRs Care

• KanCare / Kansas Medicaid / MediKan:

  • Sunflower Health Plan

  • Healthy Blue

  • UnitedHealthcare Community Plan

If your plan isn’t listed above, you may still be eligible for out-of-network reimbursement (see below for more info).

I am NOT In Network With: UnitedHealthcare Commercial, UnitedHealthcare Managed Resources (UMR), Optum, Aetna, TriCare/TriWest, Cigna, or any Medicare plans.

Using More Than One Insurance Plan (Primary & Secondary Insurance)

Some folks have more than one insurance plan—like two commercial plans, or a commercial plan and Medicaid (KanCare). Here's how that works:

• Primary insurance is always billed first.

  • You must figure out which is primary and which is secondary and let me know. Medicaid/KanCare is always secondary, but it can get more complicated if you have two commercial plans.

• Secondary insurance only pays after the primary sends back a denial or Explanation of Benefits (EOB) showing what they did and did not cover.

• This process is called Coordination of Benefits (COB).

If I’m in-network with both your plans:

• I’ll bill your primary first.

• If they don’t cover the full cost of the session, I’ll send the claim and EOB to your secondary.

• You’ll only owe whatever’s left over (which could be nothing).

If I’m only in-network with your primary insurance:

• I’ll bill your primary plan directly.

• If they don’t cover the full cost of the session, you’ll be responsible for the remaining balance. I cannot bill your secondary unless I am in network with them.

If I’m only in-network with your secondary insurance:

• I’ll still bill your primary insurance first, even if I am out of network.

• Once I get a denial from them, I’ll send that to your secondary plan.

• Your secondary insurance will then cover what they can, and you’ll be responsible for anything left over after both have reviewed the claim.

Key Insurance Terms to Understand

Insurance terms can be confusing, but understanding them helps you plan for costs and avoid unexpected bills. Here's a breakdown of the most important terms you'll encounter when using insurance for therapy:

• Copay: A fee you pay for EVERY therapy session, regardless of the length of the session. It may be a flat amount (e.g., $20) or a percentage of the total session cost (more common with higher-deductible plans). Your copay is usually listed on the front of your insurance card. I typically fall under an “office,” “PCP,” or “primary care” copay fee.

  • Here’s where it gets tricky: sometimes your mental health copay is different from what’s listed on your card, or you may not have a mental health copay at all. The only way to know for sure is to call your insurance provider or wait until your first session or two is billed and processed.

• Deductible: The amount you must pay out-of-pocket before your insurance begins covering services. You may be responsible for the full session cost until your deductible is met, but many plans cover mental health services without needing to meet your deductible. This resets yearly, usually in January.

  • For example, if you have a $3,000 deductible, you may have to pay $3,000 in medical and/or therapy services for the year before your insurance begins helping with costs.

• Coinsurance: After meeting your deductible, some plans require you to pay a portion or percent of the session cost, and insurance pays the rest.

  • E.G., if your coinsurance is 20%, you’ve met your deductible for the year, and the insurance contracted rate* is $140 for a session, you’d pay $28 and your plan would cover the other $112.

    • *A contracted rate is a pre-negotiated amount I’ve agreed to with the insurance companies I’m in-network with. It’s usually lower than my full private pay rate, but the exact amount depends on your specific plan.

• Out-of-pocket maximum: Once you’ve spent this amount in a calendar year, insurance typically covers 100% of covered services.

  • In other words, you’d finally get “free” therapy (until it all resets, likely in January).

How To Check What Is Covered By Your Insurance

I recommend calling your insurance provider and directly asking how they cover outpatient therapy services. Insurance reps often need specific billing codes (CPT codes) to give you an accurate answer about your mental health benefits. By asking the right questions with the right terms, you’ll get clearer information.

Here are the common CPT codes used for therapy to ask insurance about:

• 90837 – 60-minute individual therapy session

• 90834 – 45-minute individual therapy session

• 90832 – 30-minute individual therapy session

• 90847 – Family therapy session with the client present

• 90846 – Family therapy session without the client present (usually the therapist meeting with parents/guardians only)

• 90791 – Diagnostic intake / initial evaluation (the first therapy session)

Here are some questions you may want to ask your insurance company:

• What is my copay and/or coinsurance for these CPT codes/outpatient therapy?

• What is my deductible and how much of it have I already met?

• Do these sessions apply to my deductible or out-of-pocket maximum?

• Are telehealth (online) therapy sessions covered the same as in-person sessions?

• Is there a limit on the number of sessions I can have per year? If yes, how many?

Out-of-Network Benefits

If I’m not in-network with your insurance plan(s), it’s still possible to work with me by using out-of-network (OON) benefits, but it depends on the type of insurance plan you have. Some plans allow you to submit a superbill for partial reimbursement, while others don’t allow any OON coverage at all.

If you’re not sure what type of plan you have, check your insurance card or give your insurance provider a call.

Here’s a breakdown of types of insurance plans:

• PPO (Preferred Provider Organization): PPOs give you the most flexibility. You can usually see both in-network and out-of-network therapists, and referrals aren’t needed. If I’m out-of-network, a PPO plan may still reimburse you for part of the cost through submitting a superbill.

• HMO (Health Maintenance Organization): HMO plans usually require you to stick with in-network providers only and often require referrals to see specialists (I am not usually considered a specialist). Out-of-network therapy typically isn’t covered.

• EPO (Exclusive Provider Organization): You can see anyone within your network without a referral, but you have to stay in your network. Out-of-network services typically aren’t covered.

• POS (Point of Service): You may be able to go out-of-network, but only with prior approval or referral. These are generally rare in Kansas.

Using a Superbill for Possible Out-of-Network Reimbursement

Some insurance plans (such as PPO plans) offer out-of-network (OON) benefits, which allow you to work with the provider of your choice and get reimbursed for part of the cost. You would have to pay for the session upfront/out of pocket, then submit a superbill to your insurance to seek out partial reimbursement. If you're unsure whether your plan includes OON benefits, check your plan type above, read through your “Summary of Benefits” (the packet of information insurance gave you at sign up), or give your insurance company a call.

A superbill is a document I can provide after each session that contains all the necessary info for you to submit a claim to your insurance. It includes:

• My provider and license information

• Your diagnoses and session date

• The CPT code used (what service was provided)

• The session fee you paid

You submit this directly to your insurance company, and if your plan includes out-of-network benefits, they may send you a reimbursement check for a portion of the fee. I recommend reaching out to your insurance provider to see what your insurance will reimburse you for. Here’s a list of questions that might be beneficial to ask:

• Do I have out-of-network mental health benefits?

• What percentage of the fee do you reimburse for CPT codes like 90837 (60-minute session), 90834 (45-minute session), or 90791 (intake/first session)?

• Is there an out of network deductible I need to meet before reimbursement begins?

• What information do you need from my therapist to process the claim?

• Are there restrictions on the type of provider I can see?

• Are there any limits on the type of provider I can see to qualify for out-of-network benefits?

• Will you reimburse for therapy with a non-clinical level therapist who is under supervision? (I am an LMLP)

Private Pay / Not Using Insurance / Reduced Fee Sessions

Some clients prefer not to involve insurance at all or don’t have insurance. Whether you want to protect your privacy, don’t have coverage, or just prefer simplicity, private pay is an option. In compliance with the No Surprises Act of 2022, I provide a Good Faith Estimate to all self-pay clients. This outlines the expected costs of services for a year, so there are no financial surprises. If you have questions about this, feel free to reach out.

My current self-pay rates are:

• Intake/first session: $175

• 60-minute session: $165

• 45-minute session: $145

• 30-minute session: $125

I am actively reviewing financial hardship policies to explore whether more affordable options can be offered to those who need them and are out of network or are under/not insured. Currently, the contracts I have with the insurance companies I am in-network with require me to charge my full session fees to all clients.

In the meantime, I offer reduced fee sessions through the Open Path Collective for clients who are uninsured or out-of-network and are unable to use a superbill.

• Open Path is a nonprofit that connects people with affordable mental health care. To qualify, you have to pay a one-time $65 lifetime membership fee to Open Path if you meet their eligibility requirements, then pay a reduced rate (between $40-$70, based on our agreement) for each therapy session.

• This option is available only to clients who are not using insurance, are out-of-network, and do not want to send a superbill to their insurance provider for reimbursement.

• Spots are limited, but if you think this might be a good fit, visit the Open Path website and select me as your therapist.

To Sum it Up

If you’re using insurance and I am in network with one of your plans:

• I bill your insurance provider(s) directly after the session is completed.

• You are responsible for whatever your plan(s) won’t cover (like the copay, the full amount your deductible is met, coinsurance amount, etc.).

• If a claim is completely denied, you’ll be expected to pay my full rate.

If you’re not using insurance or paying out of pocket:

• You pay the full fee at the time of the service, unless you are an Open Path client, then you pay the agreed upon amount within Open Path’s guidelines.

• I can provide a superbill for you to submit to your insurance for possible reimbursement if eligible and aren’t an Open Path client, though cannot guarantee you would get reimbursed.