Our providers are in-network for individual psychotherapy with Aetna in Washington DC, Maryland, Virginia and/or New York. Please select the provider you are interested in working with to see if they are in-network with Aetna in your state. We are out-of-network in all other states and with all other insurance plans including Medicare and Medicaid.
We use Headway to verify and process your in-network insurance claims. If you are not in-network with Aetna in Washington DC, Maryland, Virginia or New York, payment for sessions is due at the time services are rendered. You can pay in the form of credit card, Health Savings Account (HSA) or Flexible Spending Account (FSA).
If we are out-of-network under your plan, our services qualify for reimbursement under most insurance plans. People are often surprised to learn that they have out-of-network coverage and typically receive reimbursement for 50-80% of therapy fees. We provide you with an itemized medical receipt (i.e., superbill) that you can submit for direct reimbursement to your insurance carrier. If you prefer to verify your out-of-network benefits directly with your insurance carrier, below you will find helpful questions to ask when inquiring about reimbursement.
We appreciate how confusing and stressful it is to navigate the insurance reimbursement process and strive to find ways to simplify this process and increase access to quality mental healthcare. INSPIRE Psychological Wellness can verify your out-of-network behavioral health benefits for you, or you can do this by establishing an account with Thrizer. For additional information contact us.
Once you have set up your account you can also use Thrizer’s Superbill Upload Service to upload the superbills that we provide to you. For a $2 fee, Thrizer will submit and follow up on your claim so that you never have to interact with your insurance company to secure your reimbursement. After a few weeks, you will receive your reimbursement via direct deposit.
Helpful questions to ask about when inquiring about reimbursement for out of network benefits include:
Treatment
- Does my plan cover mental health visits over telehealth? Do I need preauthorization to receive services?
- Do I have out-of-network coverage? Do I have a deductible that I have to meet prior to out-of-network coverage? If so, what is it?
- What forms do I need to submit in order to get reimbursed?
- Individual sessions: What is your reimbursement rate for out of network procedure CPT codes 90834 and 90837?
- Family sessions: What is your reimbursement rate for out of network procedure CPT code 90847?
Psychological Assessment
Most insurance companies will only cover a psychological evaluation if it is deemed medically necessary. Having a medical doctor make a referral (e.g., surgeon, psychiatrist, neurologist, physiatrist, primary care physician) can help with the insurance company’s willingness to reimburse for part of these services. It is important for you to call the number on the back of your subscriber identification card to inquire about coverage for pre-surgical psychological assessments. When you call, be sure to specify the reason for the evaluation.
Pre-employment psychological evaluations are not typically covered under insurance. For other types of psychological evaluations such as those required for surgery, ask if you are eligible for reimbursement for out-of-network psychological evaluations and if so, whether you need “pre-authorization.” The following are some of the CPT codes used for these services: 90791 (clinical interview), 96136 (testing per 30 minutes), 96130 (scoring, interpretation, feedback, and writing).
Fees
- 50 minute Individual Follow Up Appointment for Adults and Adolescents - $240
- 50 minute Family Follow Up Appointment - $270
- Psychological Evaluation – $260 per hour; evaluations typically range between 3.5 to 4.5 hours depending on case complexity. The evaluation process includes an in depth clinical interview where information regarding your medical and psychological history, psychosocial stressors, goals, expectations, and health variables and behaviors will be collected as well as emotional and/or cognitive measures. The psychologist will then write the report, which will be shared with you. The results will be reviewed and there will be an opportunity to discuss any outstanding questions or concerns.