The practice offers a range of fee rates to meet a variety of needs. Our providers’ standard fees range from between $125 to $200/session, depending upon the provider. Additionally, each provider has the discretion of offering a sliding fee scale of up to 35% off the standard rate. This sliding scale is applicable based upon financial need and scheduling availability. Financial need is evaluated based on predetermined criteria. Thus, if you qualify, it may be possible to meet with a clinician for individual services for under $100/session. We also offer group psychotherapy at $70-80/session (depending on length of group), with a sliding fee scale down to $50-60/session. In the sections that follow, we describe our services, rates, and insurance participation in greater detail.
"Insurance Friendly" Practice
We are an "insurance friendly" practice. What does this mean? It means that while we are an out-of-network provider with all plans except Highmark Blue Shield (see below and be sure to read carefully), we will be happy to provide you with detailed invoices that you can submit to your insurance company for subsequent reimbursement after each session (payment is due at time of service). In our experience, we have found that it is often possible for you to receive moderate out-of-network reimbursement from your insurance company so long as you have a PPO or POS plan. The reimbursement rates vary highly by plan, but usually run anywhere from 33 to 75 percent. In addition to supplying you with invoices, we are willing to help you navigate the insurance process by counseling you on appropriate questions to ask your insurance company regarding treatment and reimbursement.
Why don't we directly participate with most insurance companies?
- Confidentiality -an insurance company can require the submission of sensitive treatment information from in-network providers, and we have no assurance that this information will be protected with the utmost of confidentiality once it is received by that company. By working out-of-network, we can better protect your privacy.
- Treatment Management -an insurance company has the option of restricting treatment due to directives that may not match the client's needs. Examples would include the length of treatment, number of sessions, or the type of treatment used. By taking the insurance company out as the middleman, we are able to work with you collaboratively in setting the direction of your treatment.
- Time - Because psychologists are unlike doctors in that they see only one patient per clinical hour (e.g. a 50 minute session), and the visits are one-on-one (unless the modality is couples or group psychotherapy), those who choose to work as in-network providers with multiple companies must cram their schedules with large patient loads in order to compensate for the low provider reimbursement rates which are part of being an in-network participating provider. We reject this model because we believe that it is clinically and ethically important to be thoroughly prepared and "fresh" for each client that we see. This allows us to offer the highest-quality services possible. We can also save the time that would be used for insurance company calls and paperwork and instead devote it to client care.
Highmark Blue Shield Premier Blue PPO Plans
Additionally, we participate with Highmark Blue Shield’s Premier Blue PPO program. We are in-network with Highmark and other affiliated Blue Cross/Blue Shield PPO plans. This includes Federal and some out-of-area BCBS PPOs. It does NOT include POS or HMO plans. Please check directly with your plan to determine benefits and coverage (e.g. co-pay, pre-authorization, session limits).
*Please read carefully*: It is important to check directly with your Blue plan regarding our participation. Some Blue plans may have "carve outs" of mental health benefits to another independent company. In such instances, we may not participate with the company managing the mental health benefits for your Blue plan, effectively rendering our practice as a non-participating out-of-network provider. This may exist for specific plans within a Blue company, so it is important to check. For example, even though we participate directly with Highmark, certain Highmark plans have mental health carve outs to Optum Behavioral Health (with whom we do not participate), thus superceding our relationship with Highmark and making us as out-of-network providers for those plan holders.
Further, we do NOT participate with any Independence Blue Cross plans, such as Personal Choice PPO, and Keystone POS and HMO. Independence outsources all of their mental health benefits to a company, Magellan, with whom we do not participate. If you have one of these plans, we are considered out-of-network providers. You can see one of us as a self-pay client (see above), and then submit your claims for reimbursement from your insurance company. This is contingent upon your out-of-network benefits.