You have a right to know, in advance, the costs of any therapy session you schedule

Prior to your first session you have a right to know the fees for any therapy services you are considering.  The fee for your first session must be disclosed to you in advance. This fee will apply to each subsequent session you schedule, unless a different agreement is made.  Any change of the fee will be discussed and agreed to in advance of the change.  The total cost of the entire course of your or your child’s therapy will depend upon how many sessions you choose to utilize and what rate of payment applies to those sessions.  A Good Faith Estimate for the cost of services will be given to you at your first appointment if you do not have insurance or do not plan to use your insurance to cover the cost of my services.

If you have health insurance, you have a right to know the financial impact of choosing an in-network or out-of-network provider

I am a contracted, in-network provider for adults with Beacon Health Options insurance.  If you are an adult with Beacon Health Options insurance, your plan provides full coverage for your therapy sessions and there is no co-pay billed to you.  If you have a child who is covered by Beacon Health Options insurance, I can refer you to other contracted in-network Beacon providers who provide therapy services to children.  

I am out-of-network for all other insurance plans.  As such, I am permitted to set my own fee structure and I expect full payment for each session at the time of service; I do not do ‘balance billing’.

Full payment for Service:  A therapist who uses this payment option asks to collect payment in full for each session.  They may provide you with a statement that you can use to submit your claim for reimbursement from your insurer.  If your benefits include payment for services from out-of-network providers, you may receive partial reimbursement of the fees you paid.  Your therapist cannot make any assurances regarding whether your insurer will reimburse you.  You will be responsible for the full fee regardless of whether your insurer provides partial reimbursement to you or not.

Balance Billing:  A therapist may bill your insurance company on your behalf.  You may be asked to pay your therapist the difference between the therapist’s fee and the amount your insurer pays the therapist.  This is called ‘balance billing’.  If you want to know how much of the therapist’s fee you will be expected to pay, you can contact your insurer to get an estimate of how much of the fee they expect to reimburse to you.

Your costs for therapy may be less by using an in-network provider

Usually the fee limitations on in-network providers result in lower costs for you if you choose services from an in-network provider.  You can contact your insurance company to help you find an in-network provider.  There may be reasons for you to choose an out-of-network provider, and you should know that this choice is yours and also that it may result in higher overall costs to you.

If you believe you have been wrongly billed, you may contact the California Board of Behavioral Sciences at www.bbs.ca.gov/consumers/.