Understanding insurance & being out of network

Usually when people ask "do you take insurance", they are asking if we are "in-network" providers with any health insurance carriers (e.g., UHC, BCBS, Aetna) . No, we are not directly in-network with any insurance plans and are considered out-of-network (OON) providers.

However, this doesn't automatically mean that you can't use your insurance benefits! Some health insurance plans include what's called "out of network mental health benefits". If that's true for your plan, you can work with an out of network provider and submit session invoices for reimbursement, just as you would for an "in-network" therapist.

Many of our patients do this and we've seen reimbursement ranging between 25-80%, depending on the plan.

Check what reimbursement you may qualify for using our easy to use tool above.

There are many reasons we choose to be “out-of-network providers”, but the two main ones are:

1) We are freed to focus 100% of our time and energy on our work with you instead of spending countless hours on billing and insurance forms. Our therapists can use their time between sessions to attend training seminars, practice self-care, and engage in consultation or supervision so they provide you the highest standard of care.

2) We can compensate our psychologists on time and more competitively than insurance companies do - this supports their professional health and prevents burnout.

We provide invoices, or “superbills” for you after each session via email. These superbills include all of the information needed to file an insurance claim and many of our patients submit these directly for reimbursement.

We highly encourage you to follow up with your insurance plan prior to your first session to ask if there are any extra steps required to use your OON benefits.

Here are some questions to ask:

• Do I have “out of network mental health benefits”?

• If so, how much per session or what percentage of my session fee can be reimbursed?

• Do I have a deductible I need to meet first before being eligible for reimbursement? If so, what is it?

• Do I have a co-pay?

• How do I submit claims in order to receive reimbursement?

• What information is necessary in order to submit my claims?

• On average, how long does it take to receive my reimbursement check?

• Do I have a session limit or is there any pre-authorization from my therapist required?

We have partnered with Mentaya, a service that allows us to check your benefits to see if you’d qualify for any reimbursement for therapy. Our therapists can check to see if you would qualify for reimbursement for therapy and provide an estimate. Unfortunately, we cannot assist in submitting insurance claims at this time.

The CPT code is a 5-digit number used to categorize what service is being provided and billed for. Here are the most common CPT codes used:

90791 = your first 60-minute intake session

90834 = 45-minute individual therapy

For sessions that are conducted via teletherapy, the modifier “-95” is attached to the CPT code. For example, an individual teletherapy session would be 90834-95. Please ask your therapist if you have additional questions.

Yes!

One of the biggest reasons we think you should work with an OON therapist is if you are looking for a highly specialized or niche therapist - like a cognitive behavioral therapist, insomnia therapist, trauma therapist, or BIPOC therapist with multicultural training in mental health.

Most therapists can address common mental health concerns like anxiety and depression with a mix of approaches. However if you are interested in a therapist who uses a specific type of therapy, like evidence-based therapies (i.e., ones that has been researched and backed by science) or a multiculturally trained therapist - try going out of network, as they are far less common.

Keep in mind that it can be financially worthwhile to work with an out of network therapist with specialty training in your concerns so you get what you’re looking for - instead of wondering if you will (and end up spending more in the meanwhile).

Payment for therapy is due upon service. In other words, payment is expected when you attend a session - we do not bill monthly or create payment plans. We accept most major credit cards and checks made out to “Manhattan Therapy Collective Psychological Services, PLLC”. Please ask your therapist before your session if you have questions about a specific form of payment. Upon payment, your therapist will email you a copy of your completed invoice.

We know that therapy is a financial investment. Know that our session fees are not random. We make it a point to set our fees in accordance to average market value rates for the zip code we serve, the doctoral-level of training our psychologists possess, and their respective specialties. Our fee range also reflects the fact that we are committed to maintaining office space in NYC and offering the option of in-person sessions to all of our patients.

Starting January 1, 2022, out of network providers are federally mandated to provide patients a “good faith estimate” that outlines the expected cost of treatment. This is incorporated into the initial paperwork that we require all new patients to complete prior to beginning therapy. For more information about your rights, read about the No Surprises Act .