Deductibles

Much like car insurance, some health insurance plans also have deductibles, and they vary depending on the plan you have.  Unlike car insurance, they are not per incident, they are cumulative.  Healthcare deductibles are yearly, and they renew when your insurance policy renews.  For the vast majority of people, this is January 1st, each year.  However, some plans are “off-cycle,” depending on your employer, etc.  When your plan renews, your deductible starts over and you have to make payments for all claims until you have reached your deductible. Insurance keeps track of this on their end, but you should also keep track of it on yours.  Deductibles for healthcare include all of your healthcare providers.  So, if you see a dermatologist, and you see us, both of these services would be applied towards your deductible until it is met. Once your deductible is met, insurance should pay your claims according to your benefit policy.  You may still, however, have a copay.  Copays can be a flat per-service or per-day fee, or they can be a percentage of the service.  When a service is applied towards your deductible, the provider is notified (through a returned claim and explanation of benefits or “EOB”), and you are charged directly by the provider for this service, plus any credit card fees that may apply.

We STRONGLY encourage you to know what your yearly deductible is (if you have one), know what your copay is, and also know whether or not therapy services are “subject to the deductible.”  What this means, is whether or not you have to satisfy your deductible before insurance kicks in and pays.  There are some services that are paid by insurance regardless of your deductible.  For instance, all annual physicals are paid, as are pediatric visits for new babies.  Mental health services, however, are in a gray area and sometimes the deductible has to be paid before insurance will make payments, sometimes it does not.  There is no way of us knowing this until we get claims back for your services, as this information is not listed on the online benefits system.  We have also found that the online benefits system is often not accurate and sometimes will not give us any information on certain policies. As such, you should call and find out this information.  Here are the steps to take:

 1)    Call your insurance by looking at the back of your ID card and searching for the Member Services number.

2)    Ask whether you have a yearly deductible on your plan and how much has been met already.

3)    Ask if individual psychotherapy sessions (CPT codes 90791, 90837, and 90834) are “subject to the deductible” or not.

4)    Ask if you have a copay or coinsurance and what it is.

 One other note about deductibles:  If you start a job mid-year and elect their health coverage, your deductible will start at the beginning of coverage.  So, if you start a job in August, your deductible will start in August, and then it will reset AGAIN in January to be on the same cycle as the rest of the employees at the company.  Sometimes this surprises people, so we think you should know this up front.

Copays/coinsurance

Copays and Coinsurance are your portion of each service, according to your benefits policy.  Sometimes it says what your copay is on your insurance card, and sometimes it does not.  Also, some doctors are considered specialists by your insurance and some are not.  Most people either owe a flat fee per session (for example, $25, $30, etc), but some owe a percentage of the service cost like 20%.  When it is a percentage of cost, it is a percentage of the rate set by the insurance company for in-network providers.  So, for example, if the service rate is $154.44, and you have a 20% coinsurance, then you would pay $30.88 per session.  Insurance companies routinely adjust the rates (usually every December and June), so if you notice a difference in what was charged around that time of year, this is the reason why.  Typically, however, when insurance adjusts rates, it is only by a few dollars, which doesn’t make a huge difference in your coinsurance.  One other thing about copays and coinsurance:  if you have a deductible, you will pay the whole fee first until you satisfy the deductible.  Then insurance kicks in and you will pay your copay or coinsurance for each session until you meet your yearly out of pocket maximum, which most people never meet unless you had a surgery or other extensive services.

No-Show/Late Cancelation Fees

Sometimes there can be confusion about no-show and late cancellation fees among patients. We believe in full transparency at our practice and want to make sure you are aware of our policies and why we have them in place. When you book a session with us, that spot is reserved for you, and you alone. As therapists, in order for us to do good work, we limit the number of patients we will take on at any given time. For most full-time therapists, this is around 20-25 patients a week. When you do not show up for your session, you should know that your therapist expected you to show up and did not plan for anything else during that time. They also did not have a patient waiting around that they could slide into that spot (which is how we differ from medical and dental practices who often “stack” patients). If you miss your session, you become responsible for the full session fee. This means the full fee, BEFORE the insurance discount. Most people expect to just pay their copay as the cancellation fee, but this is not the case. Your insurance will not pay for services that were not rendered, and as such, if you don’t provide adequate notice in accordance with the practice cancellation policy, you will be charged that full fee.

Another reason for no-show and late-cancellation fees, is that it preserves the therapeutic relationship.  If you, as a patient, late-cancel or no-show to a session, and the therapist does not get paid, it can cause tension in your relationship and make it difficult to work together, which is not good for anyone.  This is especially true, if you late-cancel or no-show on more than one occasion.  Charging a fee for the therapist’s time, both is respectful of that therapist and also preserves the relationship so that you can continue to do good work together.

Additionally, at our practice, we are committed to a respectful working environment and fair wages and benefits for our therapists. We believe this is a moral and professional obligation. A therapist cannot do their job well if their basic needs are not met. As such, we pay our therapists whether patients show up to their sessions or not. That payment is passed onto the patient, as it is their responsibility. Patients have also asked why the practice cannot absorb that cost. This is simple. To do so, would mean that the practice would not be able to provide the same level of care and treat its employees well with fair wages and benefits. We also would not be able to offer reduced fee/sliding scale options for uninsured patients or patients who are facing financial hardship, but need services. Thus, because we are committed to providing care for patients who may need financial help and we also are committed to our therapists and their financial and personal well-being, it is the responsibility of the person who missed the appointment (patient) to pay for it. If for some reason your therapist ever has to cancel an appointment due to an emergency or being sick, you will not be charged, as you were not the one to cancel the appointment. Thank you for understanding.