Insurance Questions

The Rochester Center for Sexual Wellness is a privately owned, and privately funded organization. This means that we are not subject to any restrictions on funding or finances as universities, large medical centers, or other publicly funded programs are. Our services to you are not dependent on political changes. We also value your privacy deeply and this is an additional reason that we value our independence.

We welcome EVERYONE and are committed to holding all people to be of inherent value, worth and dignity as human beings. It is our mission to help all who seek our services to acheive better connection to their bodies, their pleasure, and in their relationships.

Insurance typically doesn’t cover the services we provide through Rochester Center For Sexual Wellness.

Let us tell you why.

1. We value your time.

   With regard to your medical care, excellent care takes time. The issues we address here are often complicated and hard for people to talk about. Sometimes people haven’t ever put the concerns they are addressing here into words. We take the time required to hear your concerns and address them fully. If we participated in insurance plans, it would limit our time together. If we accepted insurance plans, we would not be able to take the time you need to achieve your goals.

2. We value your privacy.

   When your insurance is billed for your medical care, they have a right to access the details of your medical records. Often, clients want to keep information they share here private. 

3. We are not in control of how insurers decide to pay (or not) for our services.

   Insurers make decisions on whether or not they will pay for services according to the insurance company’s determination of what is “medically necessary.” Sometimes the concerns we are addressing here are not considered “medically necessary” so the insurance company can simply refuse to pay anything for the service. Additionally, some of the other services we offer here, like couples/relational therapy, are often not included at all in the services an insurance company offers. We, here at RCSW, don’t agree with these ideas– we understand that sexual concerns are often both medically related and very important! And we know how important relational therapy is for many people’s overall health. But, we won’t be able to keep our doors open if we don’t get paid for the work we do.

4. We are a small business.

   We are able to keep your fees reasonable in part because we are not trying to negotiate payment with insurers.

However:

You may be able to use a health savings account, or you may request a statement to submit to your insurer for reimbursement according to your “out-of-network” benefits. You may want to contact your insurance company with the following questions: 

• How does my health plan cover “out-of-network” medical and mental health treatment? 
• What is the process for submitting an “out-of-network” claim?

What are Out-of-Network Benefits?

Unlike in-network doctors, out-of-network doctors are not contracted with health insurance companies. Doctors contracted with insurance companies follow insurance company “reasonable and customary” guidelines that determine the type of coverage they provide for different types of services. Though there are cases where health insurance companies will help cover the cost of your out-of-network doctor’s visit, in many cases they pay less for treatment with an out-of-network doctor, depending on what is being treated.

Why are some providers Out-of-Network?

In-network doctors are limited to treat only what health insurance companies deem “medically necessary”. This often leaves you with 10-minute visits and a prescription to treat symptoms. As an out-of-network practice, our team of specialists can take the time necessary to listen to your concerns in order to treat the root of the problem and not just the symptoms. We value a holistic approach, addressing both physical and psychological issues, without the restrictions by insurance companies.

What if I don’t have “out-of-network” benefits or I don’t have health insurance at all?

You can still be seen at our practice as a self-pay patient, even if you do not have out-of-network benefits or don’t have any health insurance at all.

How much do visits cost? 

Therapy visits range from around $80 per visit (with an intern– not always available) to $200+ per visit with our senior clinicians. Medical visits are $175 to $450 per visit, depending on the length of the visit (time booked).