Fees & Payment
Hey there, lovely humans! Let’s talk about something that can feel a bit uncomfortable but is oh-so-important: insurance. At ERA, we’ve made the conscious and very intentional decision to operate as out of network with insurance companies, and we want to share the reasoning behind that.
Spoiler alert: it’s all about you and the quality of care we can provide!
The Lowdown on Our Out-of-Network Status
You might be wondering, “Why can’t you just take my insurance? It would make life easier!”
And we get it! Navigating the world of insurance can feel like trying to solve a Rubik's Cube while blindfolded. But here’s the deal: by staying out of network, we can offer a more personalized, flexible, and high-quality therapeutic experience. Here’s why:
Privacy: When you use your in network insurance benefits, your insurance company has the ability to request your confidential medical records at any time. They may use those to decide they don’t want to pay for your treatment, or that you haven’t gotten better fast enough, or that you’ve gotten to much better and don’t need therapy anymore. We don’t think they should have access to your information whenever they feel like it, and we feel like YOU should decide when to see a therapist and which therapist you get to see.
Quality Over Quantity: Insurance companies often impose limitations on the number of sessions and the types of treatments covered. They can decide at any time that they won’t pay anymore, or want to claw back months or years of prior payments, leaving you with a giant bill. By being out of network, we can tailor your therapy to your unique needs without being bound by insurance rules. More personalized care? Yes, please!
Focus on You: When we don’t work with insurance companies, we can concentrate on providing you with the best therapeutic experience possible. No more worrying about the fine print of your coverage—just you, me, and the work we need to do together. We decide together what is right for you.
No Hidden Costs: Insurance can be tricky, and sometimes your benefits aren’t as great as they seem (cue dramatic music). By being out of network, we maintain transparency around our fees and services, so you’ll always know what to expect without any nasty surprises. Providers who take insurance aren’t allowed to share their rates, so one practice may have a fee of $75, while another has a fee of $200. If your insurance isn’t paying until you meet your deductible, you’re on the hook for that entire cost until you do meet it. Then you get a giant surprise bill in a few weeks or months. No bueno.
Avoiding the Red Tape: The insurance approval process can be a time-consuming hassle, and we want to spend our time focusing on your mental health rather than wrestling with paperwork. Staying out of network allows us to keep things simple and efficient. Then we get to focus on what we do best: helping you heal.
Using Your Out-of-Network Benefits: How to Talk to Your Insurance Company
So, you’ve decided to invest in your mental health—awesome! If you’re worried about how to approach your insurance company about your out-of-network benefits, don’t fret. Here’s a step-by-step guide for you to navigate those waters like a pro:
Call the Number on Your Insurance Card: Dial up your insurance company and ask about your out-of-network mental health benefits. Remember that the person you’re talking to is a person - and they aren’t the decision maker on what your insurance company will pay for. We know it’s frustrating, but try to be kind to them.
Ask Specific Questions:
What percentage of therapy costs will be reimbursed for out-of-network providers?
Is there a deductible I need to meet before my benefits kick in?
Are there any limitations on the number of sessions I can claim?
Will I get out of network reimbursement for a pre-licensed clinician (APSW or LPC-IT)?
What is the reimbursement rate for the following CPT codes?:
90791 – Psychiatric Diagnostic Evaluation
90832 – Psychotherapy, 30 minutes (16-37 minutes)
90834 – Psychotherapy, 45 minutes (38-52 minutes)
90837 – Psychotherapy, 60 minutes (53+ minutes)
90847 – Family or couples psychotherapy, with patient present
Get Your Claims Process Ready: Your therapist will provide you with a superbly detailed receipt (known as a superbill) after each session. This receipt will include all the info your insurance company needs to process your claim. Make sure to keep it handy!
Submit Your Claim: Some insurance companies allow you to submit your claims online, while others prefer good ol’ snail mail. Check what your insurance requires and submit your superbill with a smile.
Follow Up: If you haven’t heard back after a few weeks, don’t hesitate to check in. A friendly reminder can go a long way, and you deserve to know how much reimbursement you’ll get!
Celebrate Your Wins: If you receive reimbursement, yay you! If not, remember that investing in your mental health is always worth it, no matter the financial aspect. You are taking a step toward a happier, healthier you!
Choosing to prioritize your mental health is a brave and empowering decision. At ERA, we’re dedicated to providing you with the highest quality care without the constraints of insurance. If you have any questions about our out-of-network status or want to chat about your therapy journey, we’re always available to talk things through!