Fees and Insurance
Fees
I am an in-network provider for Tufts University students on the student health insurance plan. In that case, you are only responsible for your copay.
I am an out-of-network provider for many insurances. Those with an insurance that offers out-of-network benefits may be able to receive reimbursement for sessions. I will provide you with a master bill, which has the necessary requirements so that you can receive reimbursement for services. My fees are as follows:
Initial, diagnostic appointment: $275
Ongoing visits: $250
KAP sessions: $750 (3 hours)
I maintain a set number of low fee spots in my practice. Currently they are all occupied.
Be sure to contact your insurance provider to request more specific information about your plan's reimbursement rate, deductible and mental health coverage (I may appear in-network for your insurance plan. Confirm the practice address with the insurance company).
Some questions you could ask your insurance company:
Do I have out-of-network benefits for mental health coverage?
What is the allowed amount for an out-of-network provider for the CPT codes 90834 and 90837? The allowed amount is the maximum amount your insurance will make payment for covered health care services. A CPT code is insurance-speak for the kind of service offered, and in this case it refers to the minutes of psychotherapy.
What is my copayment and/or coinsurance? A copayment is a fixed amount you pay per session to the provider, such as $20-25. Coinsurance is a percentage of the fee that you pay. For instance, the insurance company might pay 80% and you pay 20%. However, be sure to check if there is a maximum allowed amount. Some insurances cap the amount they will pay per session.
Do I have an out-of-network deductible or out-of-pocket maximum? Some insurance plans have deductibles, which means you have to pay the fee in full up to a specific amount until benefits kick in. Other plans have maximums, which means that once you pay a certain amount in fees, your insurance covers the rest.
How many sessions per calendar year are covered? Some plans will cover an unlimited number of visits but others cap it at a certain number per year.
How do I submit a request for reimbursement?
No Surpises Act-Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical 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 bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or 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 or call 1-800-985-3059.