Expanding Care

Many clients are unsure how their specific plan works. We accept several different types of insurance plans, predominately BCBS, BCN, and BCC.

Some specific questions you can ask your insurance company:

Are outpatient mental health services subject to my deductible? I.e., Does insurance begin to cover sessions before or after I meet my deductible?

What is my in-network deductible for outpatient mental health visits?

How much of my deductible has been met this year? I.e., What remains for me to pay out-of-pocket before my insurance coverage kicks in?

You might also want to find out if you have a deductible, how much it is, and if it applies to outpatient mental health services. A deductible is a specified amount you have to pay upfront before your insurance plan begins to pay (minus a few circumstances like free preventative care if you see an in-network provider). If you’re on a family plan, your plan will have an individual deductible and a family deductible. Mental health services are not always subject to the deductible. If they are not, then your plan will start paying immediately for covered services and finding out how much your deductible becomes unnecessary.

If your mental health sessions are subject to a deductible, you’ll want to know how much it is, how much you’ve already met of your deductible this “year,” what kind of policy year you have (calendar or plan), and what your out-of-pocket-max is. Say your deductible is $5,000 and your mental health sessions are subject to the deductible, you’re going to have to shell out $5,000 in medical costs before insurance will pay a cent. However, you might have an out-of-pocket max of $7000, which means, once you’ve paid $7000, your insurance will cover everything else for the rest of the plan year. Calendar year means your deductible resets January 1. Plan year is a 12-month period of coverage that starts at a date specified by the plan. If you have a plan through your university, your plan year might begin/restart in September. I’ve even come across university plans where the “year” was every quarter, meaning the deductibles reset every 3 months! With this information, you can do some calculating to see how long it might take you to meet your deductible and your out-of-pocket max.

After figuring out your deductible situation, which is one type of cost-sharing, you’ll want to find out what your responsibility is for each session. Sometimes you can find out your co-pay (flat $ rate) or co-insurance (percentage of the contracted rate) listed on the front of your insurance card. Sometimes a mental health provider is considered a specialist (higher co-pay than your PCP) but not always. Another reason I like to talk to a representative. If you do have a deductible, you will also want to ask if your co-pay or co-insurance counts towards your deductible; if yes, you will be paying down the deductible faster than if not. You are responsible for your co-pay or co-insurance for each session until you reach your out-of-pocket deductible amount.

In-Network Benefits

If your outpatient mental health services are subject to a deductible and you have not yet met your deductible, you are responsible for the therapist’s contracted rate with your insurance until your deductible has been met. This rate varies by insurance company, location, type of service, and type of provider. You will need to find out your potential therapist’s contracted rate with your insurance, not their full rate fee. If you have already seen the therapist, you can find the contracted rate on your explanation of benefits (EOB) statement from your insurance as the “allowed charges” amount. Once your deductible has been met, your insurance will begin covering the allowed charges amount, minus your co-pay or co-insurance amount if you have one. If you have a co-pay, you are responsible for that flat amount. If you have a co-insurance, you are responsible for that percentage of the allowed charges/contract fee. Your co-insurance will change per type of session (group, individual, intake, crisis) as well as length of session (30 minutes, 45 minutes, 60 minutes) because each may have a different contracted rate.

For example, if you have met $1400 of a $2000 deductible and mental health services are subject to your deductible, your therapist’s contracted rate with your insurance is $150 and your first session intake rate is the same as all subsequent sessions, your co-insurance is 20%, and your co-insurance does not count towards the deductible:

You are responsible for paying $150 until you meet the $2000 deductible.

Remaining deductible($2000 – $1400) = $600.

Co-insurance (20% of $150) = $30.

Insurance responsibility once deductible is met (80% of $150) = $120.

Money applied towards the deductible each session (Contracted Rate – Co-insurance) = $120.

You will meet the remaining $600 deductible ($600/$120) = 5 sessions.

• Session 1 – Pay $150, $120 paid towards deductible.

• Session 2 – Pay $150, $240 has been paid towards deductible.

• Session 3 – Pay $150, $360 has been paid towards deductible.

• Session 4 – Pay $150, $480 has been paid towards deductible.

• Session 5 – Pay $150, $600 has been paid towards deductible. Deductible has been met.

• Session 6 – Pay $30. Insurance pays $120.

We provide an application you can complete if you would be interested in income-based therapy rates. This application is available after you schedule a consultation or intake appointment. If you want to access this application sooner, please contact us.