Accepted Insurance Panels
I am in-network with the most commonly used plans in the Greenville, NC area. I also work with Medicare and Tricare beneficiaries.
| Insurance Panel | Status | Notes |
|---|---|---|
| Aetna | In-network | Includes Commerical and Medicare Advantage |
| Blue Cross Blue Shield of NC (Includes out-of-state Blue Cross/Blue Shield/Anthem Plans, and NC State Health Plan/CPP) | In-network | SHP/CPP Provider Does not include Blue Advantage HMO Plans. |
| Cigna/ Evernorth | In-network | |
| MedCost | In-network | |
| Medicare | In-network *If you have Medicare Advantage, please see the next section. If your plan has HMO in the title, we may not be able to use your insurance. | You may have co-insurance for the session, $22.29 for an hour session. If you have a supplement, they usually pay all of the co-insurance. You may have to pay the $240 deductible first, if it hasn’t been met. |
| Medicare Advantage | Out-of-network *With the exception of Aetna. I am in-network with Aetna for Medicare Advantage. | Able to use and process claims for therapy sessions as an out-of-network provider unless you have an HMO plan. Co-pays and co-insurance for OON Medicare Advantage plans seem to range from $22.29-$30 for an hour session. Your plan may pay for everything once the deductible is met. |
| State Health Plan | In-network | CPP Provider, so $0 co-pay and $0 co-insurance for all therapy sessions, regardless of length. |
| Tricare | TRICARE-certified provider | Able to submit claims and receive payment from TRICARE, but I’m not in-network with Humana Military’s provider network. (I’m still figuring out what exactly this means, but we can work together!) |
| United Healthcare/Optum (includes UMR, MAMSI OneNet PPO, MAMSI Worker’s Compensation, and Oscar Health Plan) | In-network | Out-of-network for Medicare Advantage plans. See above for more info about Medicare and Medicare Advantage. |
Session Costs
All insurance plans require that providers collect any co-pays, co-insurance, and/or deductibles that are part of your plan.
Your cost is determined by your insurance plan. While I have a set fee for each of the service codes that I bill, your insurance plan has rates of which I am contracted to follow, regardless what I bill.
For example, let’s say I charged $300 for an hour of therapy (I don’t charge that amount). The service code for an hour of therapy is 90837, and your insurance only allows its members to be charged $150 for that code.
- Contractual Obligations: The difference between what was charged (i.e. $300) and what is allowed ($150) is $150. I have to discard any amount that is higher than the contracted fees from your insurance company from the amount owed. (That amount is not a tax write-off. It’s deleted.) Once your insurance plan has processed the claim, the invoice for your session will show “Exceeds allowable” for whatever that amount is.
- Plan A: Plan A states that members pay their co-pay amount for out-patient mental health office services (some plans call this psychotherapy). Your plan’s co-pay is $35. That’s your cost whether we meet for 30 minutes, 45 minutes, or an hour. Your insurance pays the remaining balance of $115.
- Plan B: Plan B states that members pay co-insurance for therapy. Your plan’s co-insurance is 30%. Since your plan has established the rate for 90837 is $150, you would pay 30% of $150, which would mean an hour of therapy would cost you $45 per your health insurance plan. Your insurance plan pays the remainder of the $150 service fee. So they would pay $105 for an hour of therapy.
- If we did a 45 minute session, the cost would be lower, since therapy is billed to insurance based on 15 minute time intervals. We round up or down depending on exactly how many minutes we meet.
- For example, your insurance company has set the rate for 45 minutes of therapy, 90834, as $120. If your insurance company required a 30% co-insurance payment from you, your cost would be $36. Your insurance would pay the remaining balance of $84.
- Plan C: Plan C states that you must meet your deductible before they will pay for any of the services. Your deductible amount is $2000. You can count the fees you pay for all of your healthcare services towards this deductible. Some plans have an in-network deductible and an out-of-network deductible. The insurance still sees this as a savings for their members, as they set the rates their members are allowed to be charged by any medical providers. Since your plan has set the rate at $150, you would pay $150 for the session.
When you start a new job or go through open enrollment, please ask your representative about the details of your plan. Often companies offer two or three options, each with a different premium that you pay. If you plan to seek out therapy, work the numbers to see which option is best for you.
Other Fees & Costs
There are some services codes your particular insurance plan may not cover. For instance, some plans cover family counseling, while others don’t. Some plans cover telehealth, some plans only cover video telehealth but not phone telehealth. Even within certain networks this can differ from plan to plan.
If your insurance does not cover a particular service, then you will be responsible for paying the fee for the therapy session. I try to verify before sessions, but insurance policies can change throughout the year.
There are some fees that insurance never covers, such as:
- Late cancellation/no-show fees
- Brief letter document fees
- Long reports
- Sessions longer than an hour*
- More than one session in a day
- Classes, retreats, intensives, and other similar offerings
Submitting Invoices for Past Sessions
If you and I have done sessions prior to my being credentialed and contracted with your insurance panel, you may submit a copy of your paid invoices (also known as a “superbill”) from our sessions to your insurance company reimbursement according to your plan.
Those session costs may count towards your out-of-network deductible amount, or you may be reimbursed for part of the costs. This will differ based on your plan.
- Blue Cross Blue Shield of NC allows you to submit 18 months BACK from the current date.
- NC State Health Plan members typically receive a decent reimbursement back from BCBS.
There are a few insurance plans that do not accept superbills:
- Medicaid
- Medicare
- Tricare
Please note: If you have Medicaid, of any of the Medicaid Community Plans, I am unable to work with you. You must receive services from someone who is a Medicaid provider.
To help you submit the invoices and be reimbursed by your plan (usually at the out-of-network rate, your plan will have more details), I’ve compiled links to the information and forms to make things easier for you. You’ll need your invoice from inside the client portal. Here’s how to find that:
Cigna has a form to complete with all of the detailed insurance information from your card. There is a fillable PDF with directions on how to complete it. You must also submit an itemized bill- which would be the invoice from the portal. All of the information asked for on the itemized bill is automatically on your invoice with the exception of two things:
You can find information about submitting behavioral health claims at these links: