Fees And Billing
What Services Are Covered
At our practice, we strongly believe that any individual in need of psychotherapeutic healing should have access to such services. Therefore, we are proud of the lengths we go by making our costs of services as affordable as possible, yet maintaining the highest quality of care. We are dedicated to making our services available to those individuals who rely on health insurance to cover their medical expenses, or to those who do not have insurance coverage. Therefore we have contracted with many major insurance plans and are also set up to offer affordable out-of-pocket fees to those who need them. While most insurance carriers have adopted a policy for coverage of individual psychotherapy and family psychotherapy, most insurance companies still do not cover marriage counseling, couples therapy, divorce mediation, premarital counseling or biofeedback. If you are seeking these types of services, we encourage you to call and verify your policy limitations with your insurance provider, or consider pursuing covered services like “individual psychotherapy” with our clinician, meanwhile pursuing other types of services as “out-of-pocket”.
Health Insurance Plans
Health plans differ in terms of their policies on coverage and reimbursement. Therefore, it is recommended to become familiar with these policies prior to your first session. For example, you may need to find out what the copayment and deductible requirements are, and how your insurance will reimburse any in and out-of-network provider ( see below our recommended questions to when you call your insurance). If your insurance plan is not contracted with our group practice to cover the fees for our services, or offers out-of-network coverage, please do not be discouraged as we can discuss an affordable out-of-pocket option. Importantly to note, that none of the insurance plans cover any missed or cancelled session fees, which will be at the discretion of your psychotherapist and the practice to charge directly. We encourage you to discuss your financial needs and the billing arrangements directly with your assigned psychotherapist and our billing team.
Some Questions To Ask Your Insurance Company
To determine if you have mental health coverage, the first thing you should do is check with your insurance carrier. Check your coverage carefully and find the answers to the following questions. When contacting your insurance plan please use Avita Integrative Care for New Jersey / Avita Integrative Psychological Care For New York or Dr. Kalman Khodik PsyD to find the correct contract, and if asked mention the CPT codes 90791 for Intake, 90837/90834 for regular out-patient mental health psychotherapy services:
- Are the above mentioned group practices contracted with the insurance plan or maybe reimbursed as out-of-network?
- What are my mental health benefits? What are my deductibles and coinsurance/copayment responsibilities?
- Is (biofeedback / couples counseling / marriage counseling, etc.) covered by this plan?
- What is the coverage amount per session?
- How many sessions does my plan cover and what limitations are there?
- How much does my insurance pay for an out-of-network provider?
- Is approval required from my primary care physician?
In-Network Insurance Plans
As a part of our service if our patients request to use their healthcare insurance plans, we will submit the claims for each session on the behalf of the client. However, benefits are not guaranteed by the insurance plans. Each carrier will hold the patient responsible for covering the partial or full cost of sessions according to their policy, especially if they fail to pay their premium to maintain enrollment in the plan. Therefore, we remind our patients to be fully informed about the status of their coverage and benefits and any coverage limitations prior to the appointment. If the insurance plan declines part or full coverage, each patient may be charged automatically for the balance without any prior notification. If we are able to be reimbursed by the insurance plan, we will credit any extra charges back to the credit card that is held on file. We are considered as an In-Network provider for the most of the larger insurance carriers as listed below, however there maybe other plans that will reimburse for services which are not yet listed:
• 1199SEIU
• Aetna
• Anthem
• Apostrophe
• Beacon Health Options | Carelon
• BHS | Behavioral Health Systems
• Blue Cross
• Blue Shield
• BlueCross and BlueShield
• Cigna and Evernorth
• ComPsych
• Empire BlueCross BlueShield
• MagnaCare
• Meritain Health
• MultiPlan
• MVP Health Care
• NYSHIP | NY State Empire Plan
• Optum
• Oscar Health
• Oxford
• UMR
• UnitedHealthcare UHC | UBH
• Wellfleet
Out-Of-Network Insurance Plans
If you are a member of a health insurance company we are not contracted with, therefore considered as an out-of-network provider, we will provide you with a detailed statement in order for you to file for a possible full or partial reimbursement with your insurance carrier. However, you will be expected to pay the full session fees at the time of service. We recommend that you contact your insurance provider to determine what your actual cost for our services would be. Historically, the majority of our clients have received 50-80% reimbursement from their insurance companies if they had out-of-network coverage for psychotherapy and biofeedback. To reiterate the above mentioned – if your insurance plan is not contracted with us or will not reimburse for our services, we will gladly discuss with you an affordable out-of-pocket option. We encourage you to discuss your financial needs and the billing arrangements directly with your assigned psychotherapist in coordination with our billing team.
Payment Options
In addition to accepting most credit cards and personal checks, we accept Flexible and Health Care Spending Accounts which are securely managed through our client portal. Please let us know about your preferred payment method at the point of paying for your copayment or deductible. The best way to start the conversation is to speak about your financial needs with your psychotherapist and ask them to coordinate with the billing to come up with the most affordable and sustainable per session fee and payment schedules.