COSTS

OUT OF POCKET

Hourly Rate as of June 30, 2024, is subject to regular adjustments which reflect inflation rates:

$165 for 50 minutes

The hourly rate for a therapy session covers a wide range of costs beyond the face-to-face time with the therapist. Here’s a breakdown of what this rate typically includes:

Therapist's Time and Expertise: The hourly rate pays for the therapist’s specialized training, experience, and expertise. Many therapists have advanced degrees, ongoing certifications, and unique specializations, all of which contribute to the quality of care.
Preparation and Documentation: Therapists often spend additional time outside of sessions to review case notes, prepare for sessions, write session summaries, and maintain client files to ensure continuity of care.
Operational Costs: Private practice therapists are responsible for their own business expenses, which may include office rent, utilities, liability insurance, equipment, and office supplies.
Licensing and Continuing Education: Therapists in private practice pay for licensing fees, professional memberships, and continuing education to maintain their credentials and stay up-to-date with the latest therapeutic approaches.
Billing and Administrative Work: Managing payments, insurance claims, and scheduling often require time or administrative support, which adds to the overall cost. For those who provide superbills, there is extra time spent on ensuring documentation meets insurance standards.
Overhead for Practice Management Software: Many therapists use software for scheduling, secure messaging, and telehealth sessions, which ensures a high level of confidentiality but also incurs monthly fees.
Insurance and Benefits (if applicable): Unlike salaried positions, private practice therapists do not have employer-provided benefits, so the rate helps cover their health insurance, retirement savings, and other personal benefits.

In essence, the hourly rate encompasses not only the in-session expertise but also the full range of supports, tools, and ongoing professional development required to provide effective and ethical care

Insurance

(SEE BELOW)

INSURANCE OPTIONS

Single-Case Agreement with Carelon/ Partnership Health Plan

A single case agreement (SCA) is a contract between an out-of-network psychotherapist and a client’s insurance company, allowing the client to receive services as if they were in-network. To obtain an SCA for telehealth psychotherapy, the client should start by contacting their insurance provider to confirm the therapist is eligible and that telehealth is covered under their plan. The client must then explain the medical necessity for continuing therapy with this specific therapist, such as a lack of suitable in-network providers or a pre-existing therapeutic relationship. The insurance company may request documentation from the therapist, including licensure information, session notes, or a treatment plan. Once approved, the agreement typically covers a set number of sessions at a negotiated rate. Both the therapist and client should review the terms to ensure clarity on billing and coverage.

Using a Superbill

Single-Case Agreement with Carelon/ Partnership Health Plan

To use a superbill from a private practice therapist with your insurance plan, follow these steps:

Check Coverage: Verify with your insurance provider if they cover out-of-network providers, as superbills are typically used for out-of-network reimbursement. Ask about reimbursement rates, any required diagnosis codes, and if there’s a deductible to meet.
Request a Superbill: Ask your therapist to provide a superbill after your sessions. A superbill is an itemized receipt that includes your therapist's details, your information, dates of service, service codes (such as CPT codes), diagnosis codes (if applicable), and the amount paid.
Submit the Superbill: Follow your insurance company's process to submit the superbill. You may need to fill out a claim form provided by the insurer and attach the superbill. Claims can often be submitted through your insurance portal, by email, or by mail.
Track Your Claim: After submission, keep an eye on your claim status. You might need to follow up with the insurance company if there are any delays or issues. Keep copies of all documents for your records.
Receive Reimbursement: Once the claim is approved, you should receive reimbursement based on your plan’s out-of-network coverage. This may be a percentage of the amount on the superbill, minus any deductible or copay amount.

If you have any questions, contacting your insurance provider’s customer service can clarify specific requirements or steps.