“In-network” health care providers have contracted with your insurance company to:

• provide therapy within a set of restrictions and

• have agreed to accept certain negotiated rates.

“Out-of-network” providers have not agreed to restrictions and charge market rates.

We are an "out-of-network" provider because we believe it allows us to:

• better protect your privacy as we are required to share less information with your insurance company (even if you use us as an out-of-network provider),

• offer longer sessions and more frequent sessions,

• offer therapy over a longer duration than compared with in-network insurance providers, and

• offer a wider range of therapeutic approaches and specialties.

Using an out-of-network provider usually will result in the insurance company paying less toward the cost of therapy. See more details in the following questions.

OUT-OF-NETWORK As explained in the previous question, we have chosen to remain an “out-of-network” provider for all insurance companies. In our experience, this allows us to provide the highest quality of care, independent from insurance-based rules or decisions.

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YOUR CHOICE TO FILE

It is your choice whether you would like to apply for insurance reimbursement or not. Even for out-of-network, usually insurance companies will pay a portion of your spending, depending on your policy.

SUPERBILL - OUR RESPONSIBILITY

As such, if you decide to seek reimbursement, we provide a “Superbill” to you which includes the standard information (such as diagnosis and treatment codes) that insurance companies require. You then submit the Superbill to your insurance company for reimbursement.

You can request a monthly Superbill as well, which can also be automatically generated on the 1st day of the month for the prior month's appointments. This will have all the appropriate insurance documentation. Some clients prefer to request the Superbill as needed or once per year. Also, some clients chose not to submit to the insurance company in which case a Superbill will NOT be created.

EXTRA FORMS - YOUR RESPONSIBILITY

Please note that we do NOT fill out any forms that may be required by your insurance company and do NOT correspond directly with them in any way. This is your responsibility but we will be glad to provide you with the necessary information. This situation is infrequent.

PAYMENT

Payment for therapy is due when the therapy takes place. Using our online system (called Simple Practice), your credit card will be charged automatically at midnight on the day of your session.

INVOICES

You will automatically receive a monthly "invoice for services" on the 1st day of the month for appointments during the prior month. This invoice will NOT have a diagnosis and other information necessary for submission to your insurance company.

ACCESS TO FORMS

You can log into the online portal and download your invoices and/or Superbills at your convenience.

SERVICES OUTSIDE OF CALIFORNIA Our therapists are only licensed to practice psychotherapy in California. Outside of California, they only provide coaching services. Coaches can NOT provide a medical diagnosis while psychotherapists can do so.

Since most insurance companies do NOT reimburse for services unless a medical diagnosis is provided by a psychotherapist, it is unlikely that coaching will be reimbursed for non-California residents. Thus, coaching services are paid "out-of-pocket" and cost between $150/session to $400/session depending on the coach. Sessions last 50 minutes.

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Insurance companies require a diagnosis for you to be reimbursed.

For couples therapy, most insurance companies will reimburse for therapy involving two people if one person has been given a diagnosis.

Please have a discussion with your therapist to make sure the appropriate partner is provided with a diagnosis. Your therapist will be able to discuss this with you in advance of making an official diagnosis. See the next FAQ for more on this.

QUESTIONS TO ASK YOUR INSURANCE PROVIDER:​ To find out more about your coverage, call your provider, get the name of the person you are speaking to, and ask the following 7 questions:

• 1. Does my policy cover out-of-network outpatient psychotherapy?
  

• 2. CPT CODES FOR PSYCHOTHERAPY: If yes, what is the reimbursement for out-of-network psychotherapy services for the following CPT codes? (See our separate FAQ on CPT codes that you can expect.)
  

• 3. Is there a maximum number of psychotherapy sessions for which they will provide reimbursement?
  

• 4. DIAGNOSIS CODES: Will the insurance company reimburse for the diagnoses which you have discussed with your therapist?
  

  • Please know a diagnosis code is different than a CPT code. A diagnosis code describes what the client (one partner in the couple) is struggling with.
    

  • If you do not have a diagnosis code yet, the most common diagnosis for a partner in couples therapy is "Adjustment Disorder - DSM-5 309.9 (F43. 20)" which is an emotional or behavioral reaction to a stressful event or change in a person's life that typically lasts 3 months or less. Usually the "stressful event" is your relationship struggle. This is generally considered a mild diagnosis that is not intrinsic to the individual and will pass.
    

  • Usually the couple will have a discussion as to which partner "wants" the diagnosis as Adjustment Disorder typically is appropriate for both of them; however, only one will be placed on the insurance form.
    

  • If a different diagnosis is appropriate, your therapist will discuss this with you.
    

• 4. % REIMBURSED: If your insurance company reimburses a percentage of the cost, what is that percentage, and what is the maximum cost per session they are allowing?
  

  • For instance, they may reimburse 70% of a psychotherapy session (CPT code 90837), but assume that the maximum rate of the psychotherapy session is only $120 (instead of the actual rate). This would mean the client would be reimbursed $84 per session.
    

  • Another insurance company, however, may only reimburse 50%, but allow a $300 hourly rate, meaning that the client would be reimbursed $150 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.
    

• 5. Is a doctor’s referral required and/or is pre-authorization required? What is the name and number of the person to be contacted for pre-authorization?
  

• 6. DEDUCTIBLE:

Is there a deductible and how much is it? Is it a yearly deductible? How much of the deductible do I have left over to meet?

• 7. ADMINISTRATIVE:

How do I file on-line? What is the address of the office where I should send my claims? To whose attention is the claim to be sent?

You should speak to your clinician about your CPT Code but here are typical ones that we typically give in our practice.

• Individual therapy codes: 90834, 90837

  • 90832 - 16-37 minutes 90834 - 38-52 minutes 90837 - 53 or more minutes
    

• Couples or family therapy code: - This is our most common code used by far.

  • 90847 - 26 minutes or more
    

• Telehealth individual and family codes codes are the same as shown above but with "-95" at the end. For example, the most common code for a telehealth couples session would be 90847-95.
  

• Your insurance company should understand what a “CPT code” is, and should be able to tell you whether they reimburse for these specific codes.
  

• CPT CODES FOR COACHING: Some progressive insurance companies and/or employers reimburse clients for healing and well-being coaching. You can ask your insurance companies or employer if they reimburse for the following codes:
  

  • • 0591T-95 Health and Well-Being Coaching face-to-face; individual, initial assessment

  • • 0592T-95 individual, follow-up session, at least 30 minutes
    

  • Note: Superbills for coaching will NOT have a diagnosis code which may be required by your insurance company.

HSA & FSA DEFINED:

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are types of tax-advantaged savings accounts that allow you to set aside money on a pre-tax basis to pay for "qualified medical expenses."

By using untaxed dollars in an HSA or FSA to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your out-of-pocket health care costs.

DETERMINE IF OUR SERVICES QUALIFY:

Therapy clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of therapy expenses.

Also, coaching clients have also been successful if their doctor writes a note prescribing health and wellness coaching (Current Procedural Terminology (CPT) codes for health and well-being coaching are 0591T, 0592T, and 0593T).

Please know that we are not tax specialists so it is your responsibility to determine whether our services qualify as "qualified medical expenses."

We recommend that you speak to your tax advisor and/or the FSA administrator if you are unsure about this determination.

If you decide to use your HSA or FSA, please enter your HSA or FSA card into our payment system when prompted to do so.

DOCUMENTATION:

We will be glad to provide a Superbill that can serve as documentation for your HSA or FSA account. The Superbill will have important information that may impact whether the service qualifies.

Please refer to the previous question to see the CPT coding that is common in our practice. Also, note there are different codes for therapy (if you live in California) and for health and wellness coaching (if you live outside of California).

FEE RANGE: Depending on your therapist, our fees range from $150/session to $350/session. Sessions last 50 minutes.

FINDING OUT YOUR FEE: After you complete the contact form, you will be assigned a therapist or coach who will inform you of her or his fee per session.

TOTAL COST: The length of therapy varies a great deal based on your goals but a typical couple may be in therapy weekly for two months and then every other week for another two months. The majority usually end up spending from $1,000 to $5,000 on counseling depending on how much help is needed.

PERSPECTIVE: To put the cost of couples counseling in perspective, it is difficult to buy something for $5,000 that will give you the same quality of life that a healthy relationship provides. Consider the emotional costs of your ongoing conflicts have been to each of you as well as your family and friends. What is the value of feeling and interacting more lovingly, effectively and respectfully now and in the long-term? This is probably your most significant relationship, which radically impacts your life and your wellbeing. Getting help to communicate with your partner in more effective and lasting ways may be one of the best investments you can make. If you and your partner feel loved, respected and meet each other's emotional needs, you may be able to do without many other material things and feel much more fulfilled.

If our services are too expensive, we are glad to recommend lower fee services.

In fact, there are places that are subsidized in various ways and can offer very low fees. Please review the sites below for yourself to assure the quality of the therapy and be sure to ask about their focus on couples.

OpenCounseling.com

Open Path

Shine A Light Counseling Center

California Family Institute

The Relational Center

The Maple Center

Better Help

Talkspace

Gronowski Center in Palo Alto, CA

https://www.paloaltou.edu/gronowski-center

More affordable options: