Some of our licensed psychotherapists accept insurance. Different providers are on different panels, so please inquire with us about your specific policy.
Information, Definitions & Important Considerations
Coverage:
If the provider you wish to see is NOT covered by your insurance plan, you can ask your insurance company if they have an option for out-of-network providers and find out the terms. In addition, please remember that at BMC we have a sliding scale for fees for clients paying out-of-pocket. Sometimes Blue Mountain Center providers who are not on the panel (accepted provider list) for your policy will accept as their fee the amount that you would have paid as a copay with your insurance.
Deductibles, Copays, Co-Insurance:
Many insurance policies have changed in recent years to a higher copay and much higher deductible. Deductibles often start over every January 1st.
The deductible is the total amount you must pay out of pocket for your health care that year before the insurance company will begin to cover services. It can be a few hundred to many thousands of dollars. Check your annual policy update or call the customer service number on your insurance card for this information. Please talk to us about what level of payment you can afford while meeting your deductible; we will be happy to work with you on the best payment options for your situation.
The copay, or sometimes copay plus co-insurance, is the amount you pay each session. Often this amount is listed on your insurance card. The copay/coinsurance for our services will be the same amount as that for "PCP" or "Primary Care Provider," if listed. If the amount is not on the card, you should be able to find out by calling the customer service number on the insurance card. We will bill your insurance company for the rest of the session fee, determined by the amount that your policy will reimburse us. Further, if your situation requires, we can give you a bill or receipt with the required information so you may submit it for reimbursement to you.
Diagnosis:
Most insurance companies require that we document some sort of significant problem (depression, anxiety, addiction, post-traumatic stress, etc.) to establish "medical necessity" for our services. The HIPAA law is supposed to guarantee confidentiality, but you will likely have to agree that the provider of an insurance policy can have access to your medical history. If we have billed them for our services, this information may be shared. We will discuss with you what diagnostic category seems most appropriate to us for the problems/symptoms you tell us about. If you are not using insurance, we will still include diagnoses in your records if there is something obvious, but we are also free to work with you on more ordinary relationship and life situation issues without recording a diagnosis where none is needed.
Questions to Ask Your Insurance Company:
- Does your policy cover outpatient mental health services?
- Are there restrictions on what credentials (licenses) or what individual providers are covered by that insurance company?
- What is the amount of your deductible? Is the mental health deductible combined with the regular medical deductible, or is it tallied separately?
- What is your copay, or your copay plus co-insurance, amount (if not indicated on your card)? If it's a percentage, ask for the figure that it is a percentage of, since this varies. They may want a CPT code for looking this up (90791 for first "intake" session, 90837 for other regular individual therapy session).
Remember that you're paying for this policy and have a right to ask all the questions about it that you wish. Feel free to discuss any of this with us if you have further concerns.
