Insurance Coverage

Insurance Coverage

We take pride in the time and care we give to each patient. Insurance plans often severely limit the time a practitioner can spend with a patient and sometimes the kind of care (for instance, couples therapy is not covered by most insurers); therefore, most of our providers do not participate in network plans.* You may be able to use a health savings account, or you may request a statement to submit to your insurer for reimbursement. 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 “reasonable and customary”. 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 “reasonable and customary” restrictions by insurance companies.

What if I don’t have insurance or my insurance isn’t accepted?

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.

Why Don’t All Your Providers Participate As “In-Network”? 

We feel we can offer you better care and more privacy outside of insurance. Excellent care takes time. If we accepted insurance plans we would not be able to achieve these goals as well as we do. 

Additionally, 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. 

Third, we are a small office and are able to keep your fees reasonable in part because we are not trying to negotiate payment with insurers. If you are concerned about your ability to pay, ask about our sliding scale fee (based on household annual income). We would not be permitted to offer a sliding scale if we had a contract with your health insurance. 

How much do visits cost? 

Therapy visits range from around $50 per visit (with a trainee) to $150 per visit with our senior clinicians. Medical visits are $180 to $220 per visit.  

*Daniel Rosen, LCSWR, CST is “in-network” for some insurers, but not all services are covered.