Frequently Asked Questions:
Payment and Fees
Do you accept insurance?
We are not “in-network” with any insurance, which means we do not accept any insurance directly. Our clients pay by keeping a card on file that is charged after every appointment (paying by cash or check when in person is also an option). For clients working with a fully clinically licensed therapist, we then are able to provide you what is commonly known as a “superbill,” which is an itemized receipt of the sessions that you can submit for “out of network” reimbursement. Our rates for therapy range from $170 to $215, depending on the therapist and type of service provided. In order to provide you with a superbill, we are required by the insurance companies to give you a psychiatric diagnosis to prove “medical necessity.” We will of course discuss with you any questions or concerns you may have about this.
What if I don’t have insurance or the ability to pay for therapy?
All of You Therapy is a registered provider to accept payment for sessions through the Pennsylvania Victim’s Compensation Assistance Program if you are a victim of a crime. Survivors of sexual assault (in childhood or adulthood) are not required to have reported the crime to police and are eligible for up to $5,000 in funding for therapy services if the crime occurred in adulthood and $10,000 if the crime occurred in childhood. Parents are eligible to apply for funding on behalf of their children. Reach out if you have questions, and we would be happy to provide more information. Consider filling out the form for the Compensation Fund.
How do “Out of Network” benefits work?
Out of Network benefits mean that instead of paying a co-pay like you would with an in-network provider, you pay the provider’s fee up front at the time of service. You then are able to submit the “superbill” to your insurance company (typically through a member portal online), and your insurance company may reimburse you a percentage of the fee for therapy after a deductible (a dollar amount you pay before insurance begins to pay/reimburse anything) is met. This dollar amount can vary widely, from hundreds to thousands of dollars.
How do I know if I have Out of Network benefits?
Typically, if your insurance card includes words like “personal choice”, “preferred provider” or "PPO,” that means you have out of network benefits. If your insurance card includes letters/words like “HMO,” that likely means you do not have out of network benefits. The best way to verify this is to call the member services number on the back of your insurance card.
What questions should I ask when calling the insurance company?:
Do I have out of network benefits for outpatient mental health services?
Are telehealth services eligible for reimbursement (if you are wanting to continue doing therapy via telehealth)?
Your insurance company may ask you what the “service code” is. Here are the service codes we may use:
90791: Psychiatric Diagnostic Evaluation (For first appointment)
90837: 60 minute psychotherapy
90834: 45 minute psychotherapy
90847: Family Psychotherapy with patient present
90846: Family Psychotherapy without patient present
90832: 30 minute psychotherapy (would only be used if session is cut short for any reason)
What is my deductible? You may want to ask about if there is a separate individual and family deductible, if you are on a plan with others from your family. This means that if your family meets the family deductible (for example: if one of your family members had many medical expenses) then insurance starts reimbursing right away even if you have not had any other medical expenses prior to starting therapy.
(If you do have out of network benefits) What percentage of the fee is reimbursed after I (or my family) meet the deductible? Is this percentage calculated from the therapist’s fee or a “usual and customary” rate?
**A ‘usual and customary’ (UCR) rate is a dollar amount that is often difficult to obtain from the insurance companies, as they typically prefer to keep this number secret. We like to educate potential clients about this so you can make an informed decision about what you are able to afford. The last thing we want is for you to take the brave step to begin therapy and have to stop prematurely due to incomplete information about what insurance will cover/reimburse. For example, if your insurance company says they reimburse 50% after the deductible is met, but they only reimburse 50% of the UCR amount rather than the therapist’s fee, then the amount you receive in reimbursement may be less than 50% of the therapist’s fee.
Why does All of You Therapy not take insurance?
Insurance companies often like to dictate the type of treatment you are able to receive or the amount of sessions you are able to have per year. We know humans don’t work like that, and true healing and change doesn’t come in a pre-designed package that doesn’t take your individuality into account. We value and commit to being able to treat you like the unique human you are and tailor treatment to what will be most effective for you.
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YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
(OMB Control Number: 0938-1401)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most that those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.
You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed or for more information about your rights under Federal law, you may visit: www.cms.gov/nosurprises or call 1-800-985-3059.
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 www.cms.gov/nosurprises.