Each provider chooses which insurances they would like to accept. Each provider has listed their insurance contracts under the Therapists tab. In your initial screening call, it is your responsibility to know which insurance you would like to bill so that we can work to match you with an in-network provider. If your current provider changes their insurance contracts, you will be informed by a letter in the mail, or verbally in session, with a minimum of 30-day notice.

If you wish to see a provider out of network, you may do so, but are not guaranteed to receive coverage. See “What if I have an Out of Network Insurance” below.

It is your responsibility to know your coverage ahead of your first appointment. If you are unsure, we are happy to bill your in-network insurance and wait for payment, however, you will be responsible for any back co-pays or deductible payments owed at that point. Insurances can take up to 6-8 weeks to send a payment for a session initially, so this could add up. It is better for you to have the following information ahead of time: 

1. What is your annual deductible and how much have you paid toward it? 

A deductible is an out-of-pocket expense that you have to pay prior to your coverage kicking in. For example, if you have an $800 deductible and have not seen any other healthcare providers this year, you will be responsible for the full contracted fee for service until you or a family member have paid $800. After that point, you will only have to pay your co-pay.

2. What is your co-pay after the deductible is met? 

A co-pay or coinsurance is the out-of-pocket portion of the fee for service that you are responsible for paying. Your insurance will cover the rest. Some insurances state-specific dollar amounts for an office visit (e.g., $15) and some will state a percentage (e.g., 20%). Sometimes this number can be found on the front of your card under office visit. If your card doesn’t have this information, you can typically go online to your insurance client portal and figure this out. You can also call your insurance and ask. If you are asked, our sessions bill as an office visit for behavioral health and more specifically as a 60-minute psychotherapy session.

3. What is your out-of-pocket maximum for the year? 

Most insurances have a stated maximum amount that you will be responsible for in a given year, for instance, $2500. After this amount, they should cover any services you receive 100%. Your deductible payments and copay payments usually go toward this. It is possible that you will not meet this amount within the year, but it is a good idea to know to avoid overpaying for services. In the event that you overpay, it could take time to get that money back.

If you wish to see a provider that does not accept your insurance in-network, you may choose to do so. As we do not bill out of network, you will be responsible for paying the full rate at the time of service. See our Services/Rates page under the For Clients tab for more on rates. 

You are responsible for submitting a claim to your insurance if you wish to receive reimbursement. To help you get coverage, we will send you a monthly superbill that you can submit. You should note that a Superbill does not guarantee coverage for out-of-network providers. You are responsible for knowing your coverage and should check if you have out-of-network coverage prior to your first appointment.

A superbill is a document that has pertinent information about services that you have received and paid for from an out-of-network provider. It typically includes things like provider information, date of service, client name and date of birth, billing code, description of service, diagnosis, length of service, and amount paid. Essentially, it looks like a very detailed invoice/receipt. 

You will receive this superbill via mail or email monthly, and at your request, for all services received in the past 30 days. You can then submit this document with a claim to your insurance to receive reimbursement. Keep in mind that if you do not have out-of-network coverage, this will likely be rejected, and you will still be responsible for the fee. Each company may have additional forms they want you to fill out with your request for reimbursement. 

Many have client portals with this information, but you can also call the number on your card to learn how they prefer you submit your information. When you reach out, it is a good idea to ask them how to submit a claim for services you received and paid for out of network, what forms you need in addition to a superbill, where you need to send the forms, and how long you can expect to wait. If your claim is rejected due to not having all the pertinent information on the superbill, please contact our main number and we will see this is corrected for you.

Many insurances only cover group therapy on a case-by-case basis. We do not work on insurance approvals or insurance billing for group sessions and only accept cash for groups. If you wish to receive a superbill for your group sessions, we are happy to provide one at the completion of all group sessions and after you have paid for them in full. However, this does not guarantee your insurance will reimburse you for any group sessions.

Insurance companies do not typically contract with student counselors, or cover sessions completed by a student counselor. Therefore, we cannot bill insurance for your session or offer a superbill. However, we do offer a reduced rate to you for these sessions.

First, this is a boundary that allows me to value both my time and the time of my clients. It is important to me to be able to fit everyone in while maintaining a manageable schedule. Setting clear boundaries like this is one way to make sure they get scheduled and that you will have your provider’s undivided attention.

Second, my goal is to provide support so that you feel that you are empowered to manage challenges on your own. Of course, this may not be true right away and I do want to make myself available if you need a quick question answered or to follow up on something. I am available for brief phone calls for free for this reason. However, if either of us feels you need more support between sessions, we may need to discuss increased frequency or, in some cases, a higher level of care. 

Third, I have noticed that sessions tend to be more productive if we are not having smaller check-ins throughout the time between sessions. It may seem counter-intuitive, but when we both are able to value the time spent in the session, while you work to implement strategies between sessions, we can more productively discuss what worked and what didn’t for you while you were on your own. This will allow us to ultimately make progress more quickly.

Beginning Jan 2022, healthcare facilities are required by law to provide information about client rights under the No Surprises Act and are required to provide a Good Faith Estimate of cost of services to all clients that are not using insurance to cover their services. Here is what you need to know about these:

The No Surprises Act is intended to protect the consumer, you, from receiving bills for services that are in excess of what you were expecting to pay. It requires healthcare facilities to provide you with an estimate of service costs, kind of like what you get when you to a mechanic or other service provider, prior to receiving care. Of course, there are times when you may not be able to receive this in advance, such as when you go for emergency services. In this case, the law protects you from “balance billing.” This means that if a doctor at a hospital you are taken to is out of network, the facility cannot charge you more than you would have paid in-network without your permission. If you are unable to give consent, you cannot be billed more than you would have paid in-network. You will still have to pay your copays, deductibles, and coinsurance as you would with an in-network provider. An out-of-network provider may ask you to sign a waiver giving up your rights under this law. You may choose to do this if you would like to see this provider out of network or if you do not have insurance. You are NEVER required to sign this. However, if you choose not to give up these rights, and the facility does not have an in-network provider that can see you, the facility may choose to refer you to an in-network provider.

The Good Faith Estimate is a document that you should be given IF you are receiving services out of network, are not billing insurance, and/or do not have insurance coverage for the service being provided. This document should have services that are going to be provided and the cost of these services. If your final bill exceeds the estimate by an excessive amount, you have the right to dispute the charges.

Lycan Counseling provides Good Faith Estimates to all clients seeing student counselors, associate providers, and those who are out of network with insurances. Your provider will also discuss this with you in your free phone consultation and provide you with this information via email ahead of your session. Our session fees are also listed in the policies and informed consent documents each client must sign to initiate services.

For more information, you can go to
https://www.cms.gov/nosurprises/consumers.