Insurance and Fees

Do you take insurance, and how does that work? 

Yes!, most insurance plans are accepted in addition to private payment.  It’s your responsibility to be informed of any co-pay, deductible, or co-insurance due. To determine if you have mental health/behavioral health coverage through your insurance carrier, the first thing you should do is call them. Check your coverage carefully and make sure you understand their answers. Some helpful questions you can ask them:

  • What are my mental health/behavioral health benefits?
  • What is the coverage amount per therapy session?
  • How many therapy sessions does my plan cover?
  • What is my behavioral health co-pay?
  • Is there a co-insurance?
  • Will my insurance pay for both in-network & out-of-network providers?
  • Is approval required from my primary care physician?
  • Are prior authorizations required? If so, the client has responsibility to obtain & provide authorization number to the clinician prior to appointment.
  • Have I met my deductible?

Keep in mind, that if a deductible has not been met, the session fee may be due at time of session until the deductible has been satisfied.

In order to qualify for insurance reimbursement, a formal diagnosis of a DSM classification must be made for billing (DSM stands for Diagnostic and Statistical Manual for Mental Disorders. It is the manual published by the American Psychiatric Association which lists all classifications of mental disorders).  

This is an important factor when deciding to use your insurance benefit versus private payment and maintaining your confidentiality and privacy. 

Courtesy electronic medical billing and/or documentation can be provided if clients wish to submit to an insurance company.  Most insurance plans are accepted as an in-network provider (see below).  Many insurance companies have “Out-of-Network” benefits, and after a deductible is met, sessions are often covered at 50 or even 80 percent. This is individual and specific to each and every plan and something you should discuss with your insurance provider.

Insurance Plans Accepted:

  • First Choice Health
  • Cigna
  • Medicare
  • Premera Blue Cross, Blue Card plans
  • Regence Blue Shield
  • Asuris Northwest
  • Aetna
  • Tri-Care West (MHN)
  • Uniform Medical Plan (UMP)
  • Call to discuss your insurance, there are many umbrellas to coverages.

Out-of- Network – Not all Insurances listed here, call for details.

  • Kaiser Permanente of Washington – May provide benefits as an Out-of-Network Provider
  • Providence Kadlec – Typically provides benefits as an Out-of-Network Provider
  • BAS Health- Benefit Administrative Systems – Typically provides benefits and covered services.

Payment is due at time of service.  Forms of payment accepted: Cash, Check, and HIPAA secure credit card processing:

  • Visa
  • Mastercard
  • American Express
  • Discover
  • Health Savings Accounts (HSA) & Flexible Spending Accounts (FSA) through Ivy Pay

GOOD FAITH ESTIMATE

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t use insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a good faith estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit http://www.cms.gov/nosurprises