We are an out-of-network provider which allows us to provide treatment that will best meet your specific needs, rather than adhering to what your insurance company believes is suitable for you. The majority of our clients are reimbursed for 60 to 80% of session fees after meeting their out-of-network deductible. We provide monthly superbills so you can submit for reimbursement. Without coverage, service fees range from $175 to $225 per appointment.
To best understand your coverage, call your insurance company and ask the eight questions on our call script below.
Insurance FAQ
We understand that most clients find insurance information confusing and have answered some frequently asked questions in hopes of educating and easing as much stress as possible. Please reach out to us with any additional coverage questions you have.
What is a deductible?
The amount of money you have to spend before insurance benefits kick in. This resets once a year. An “in-network” deductible and “out-of-network” deductible are two separate things.
What is an “in-network” provider?
A therapist who has a contract with your insurance company with an agreed upon rate for services. After meeting your in-network deductible, you owe your therapist a set copay each appointment and your insurance company will pay the rest.
Why is it difficult to find a therapist who is in-network?
What is an “out-of-network” provider?
A therapist who doesn’t have a contract with your insurance company but can still bill them for coverage. After meeting your out-of-network deductible, you owe your therapist a percentage of the session fee each appointment and your insurance company will pay the rest.
What is “private-pay”?
An option for clients who don’t have coverage or don’t want to use their insurance benefits.
Why can't NYCMHC let me know what my coverage is?
Insurance companies will not disclose all personal coverage information to healthcare providers. Information such as the “allowed amount” (see question 8 on our call script) is needed to accurately estimate treatment costs. Because of this, clients are responsible for understanding and stay up-to-date on their out-of-network coverage.
Call script to check your out-of-network benefits:
Call the member services number on the back of your insurance card and ask the below questions. The insurance representative will most likely ask for a CPT code for the specific service. 90834 is for Individual Therapy and 90847 is for Couples Therapy.
1. Do I have out-of-network coverage for routine, mental health, telehealth appointments?
2. What is my out-of-network deductible for routine, mental health, telehealth appointments?
3. How much of this yearly deductible have I met so far?
4. When does my deductible reset?
5. What is my out-of-network coinsurance for routine, mental health, telehealth appointments?
6. Is pre-authorization required for out-of-network, routine, mental health, telehealth appointments?
7. Is there a limit to the amount of yearly sessions I can have for out-of-network, routine, mental health, telehealth appointments?
8. My provider charges $200 per session for out-of-network, routine, mental health, telehealth appointments. Can you confirm that the “allowed amount” AKA “Usual, Customary, and Reasonable” rate is not less than this?
* Unfortunately, you may get different information from different representatives which is why we recommend that you ask for a reference number and the representative’s name at the end of the phone call to save for your records.
Our billing process:
Clients pay in full per session via their preferred payment method such as credit card or FSA/HSA. Monthly superbills (out-of-network claims) are created for you to submit to your insurance company for reimbursement. We can advise on services that help you submit claims if you are unsure of how to do this yourself. Reimbursement checks are mailed to you and are yours to keep.
Location:
7 W. 30th Street, Floor 11, New York, NY 10001
* Please note that all sessions are currently conducted virtually