A community of Licensed WEllness Professionals.

Fees and Out-of-Network Insurance Benefits for Individual and Group Therapy Sessions

Our individual therapists each have a different fee structure for individual therapy.  All of them offer a sliding scale range of fees for individual therapy depending on your financial situation. Individual therapist fees range from $40-$120 per 50 minute session. Fee arrangements are based on therapist experience, level of education, certifications and client's ability to pay. Our group therapy sessions are all $40 per session.

Payment is due on the day of service. You may pay by cash, check or credit card.  As part of your intake process, your therapist may ask for authorization to bill your credit or debit card even if you plan to pay cash for most sessions.  If you do not pay at the time of services, your card will be charged.  If your check is returned for insufficient funds, your card will be charged for the session.  If you fail to call in advance to cancel scheduled appointments, your card may be billed for the session.  

Please click here to see which of our Wellness Associates accept insurance. Those of our Wellness Associates who do not accept any in-network insurance plans may be able to work with you to submit claims for out-of-network benefits. 

Submitting for Out-of-Network Insurance Benefits
Your therapist can work with you to submit claims for Out-of-Network health insurance benefits. Here is what you need to know:

Instructions For Calling Your Insurance Provider

  • Call the number on the back of your insurance card for the Benefits Department. 
  • Write down every answer you receive. You'll need careful records later if the company fails to follow through with what they've told you.
  • Don't be intimidated. Ask for explanations of anything you don't understand. 
  • Ask to speak to a supervisor if you are not happy with the answers you are getting.  

Questions to Ask Your Insurance Provider

  • What is your name and extension number? ­___­­________________________________
  • Does my policy cover Out-of-Network, LCSWs, LPCs, LMSWs, or PhDs? ____yes   ____no
  • My therapist is willing to provide a statement of (a) Session Dates Attended, (b) the CPT code, and (c) the Diagnosis. Is this acceptable to the insurance company? ____yes   ____no 
  • Does my policy cover:
    • Individual Psychotherapy? (CPT code 90837) ____yes   ____no 
    • Group Psychotherapy? (CPT code 90853) ____yes   ____no
  • What mental health Diagnoses are NOT reimbursable? __________________________
  • How many Sessions are covered per year? ___________________________________
  • What is the Lifetime Maximum for mental health benefits? $______
  • What is my Out-of-Network Deductible? $______
  • What is the Allowed Amount of the fee?  (Please read important note!)
    • Individual session ($40-$120 depending on therapist): $______
    • Group session ($40 - $60 fee, CPT code is 90853): $______
  • What percent of the Allowed Amount will be reimbursed? ______%
  • How do I file a claim? ____________________________________________________

Important Note: Please read carefully!
Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid, or $96 for a $120 individual session. Other companies will substitute the $120 fee for what they deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you 80% of the “allowed amount” of the fee. You paid $120 for an individual session, but your insurance company only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number.

Important Considerations
Insurance reimbursements will vary from month to month:

  • At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit.
  • In January of each year, you will not get any money back until your deductible is met. If you apply other family medical expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.
  • Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited.

Your out-of-pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."
Ask your accountant about taking a medical tax deduction for psychotherapy.
You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network therapy (called Preferred Provider Organization, or PPO).

Why Do Some Wellness Associates Not Accept Any Insurance Plans?
Those of our Wellness Associates who do not accept any insurance plans do so for a variety of compelling reasons. Some of these benefits include:

  • More time spent with clients (and less time doing billing paperwork)
  • More privacy for clients, as the Wellness Associate is not required to report information to a third party for billing purposes
  • More flexibility in the length of each client's treatment and the problems for which clients can receive services
  • More autonomy and decision making power for clients and Wellness Associates to design a treatment that best meets each client's needs, rather than following standard insurance requirements

We work closely with the following individual therapists who accept insurance at their office locations outside of Gateway Wellness Associates: