1. The Nature of Insurance Rates and Coverage

Insurance reimbursement rates, copays, coinsurance, and deductibles are determined solely by your insurance carrier and your specific plan network. Our practice does not set these rates, nor do we have control over updates, adjustments, or sudden changes made by your insurance provider. While we are contracted providers with various networks, your financial contract is ultimately between you and your insurance company.

2. Verification of Benefits vs. Final Liability

As a courtesy to our clients, our billing team contacts your insurance carrier to obtain an estimate of your session costs (copays, deductibles, or coinsurance) prior to your first appointment. However, the information we receive from your insurance provider is an estimate, not a guarantee of payment. Ultimately, your insurance policy is a private contract between you and your insurance carrier, and you are fully responsible for all costs, fees, and balances not covered by your insurance.

3. Client Responsibility to Verify Coverage

Because insurance policies can be complex and change without notice, we highly recommend and request that you contact your insurance company directly to verify your mental/behavioral health benefits. When you call the member services number on the back of your insurance card, we recommend asking the following questions:

• Do I have outpatient mental health/behavioral health benefits?

• Does my plan require a prior authorization or a referral for outpatient therapy?

• What is my copay or coinsurance amount per session?

• Do I have an annual deductible to meet before my insurance covers sessions, and how much of it has been met?

4. Our Common Billing Codes (CPT Codes)

To get the most accurate information from your insurance representative, please provide them with our most frequently utilized Current Procedural Terminology (CPT) codes to check your specific coverage:

CPT Codes & Description

• 90791: Psychiatric Diagnostic Evaluation (Initial Intake Assessment) This is your first session!

• 90837: Psychotherapy, 60 minutes (Routine individual session)

• 90834: Psychotherapy, 45 minutes (Routine individual session)

• 90832: Psychotherapy, 30 minutes (Routine individual session)

• 90847: Family or Couples Psychotherapy (with client present)

• 90846: Family or Couples Psychotherapy (without client present)

Note: Depending on your care plan, clinical or integrative modalities may be utilized during these time blocks, but they are generally billed under the standard psychotherapy evaluation and time codes listed above.

5. Retroactive Insurance Denials (Clawbacks)

Occasionally, an insurance carrier will initially approve and pay for a claim, only to retroactively deny it months later during a routine audit or a coordination of benefits update—a process known as an insurance "clawback."

• Our Commitment: In the event of an insurance clawback, our billing team will work diligently alongside you to submit appeals, correct administrative errors, and advocate to get the claim re-processed correctly.

• Final Client Responsibility: If, despite our best efforts, the insurance carrier ultimately refuses to re-process or pay for the sessions, the final financial responsibility for the unpaid balance falls on the client.

6. Gaps in Coverage & Financial Hardship Options

We believe that unexpected billing hurdles or sudden gaps in insurance coverage should not disrupt your clinical care or therapeutic progress. Because we are dedicated to providing accessible care to our community:

• Sliding Fee Scale: If an insurance denial, deductible issue, or a change in your financial situation makes out-of-pocket costs unmanageable, you may request our Sliding Fee Scale Application.

• NHSC & Federal Poverty Guidelines (FPG) Compliance: In alignment with our National Health Service Corps (NHSC) contract, we offer a tiered Sliding Fee Schedule based on household size and annual income under the Federal Poverty Guidelines. Approved applicants will have a discounted rate applied to their outstanding clinical balances based on their qualifying tier. For individuals and families in our lowest income bracket, fees are reduced to our minimum nominal charge of $50 per session.

• Requirements: Please note that to comply with federal regulations, an official application and standard proof of income must be submitted and approved before any discounted rates or nominal fees can be applied to your account.