Fees and Insurance

"What are your fees and how do you handle payments?"

My psychotherapy fees:
  • The standard rate for individual, family, or couple therapy is $125/ standard "hour” (38-52 minutes) when insurance is being used.  Co-payment (the amount you are responsible for) is expected at the time of service.
  • The standard rate for individual, family, or couple therapy is $125/ standard "hour” when paying "out-of-pocket" ("self-pay").   Full payment is expected at the time of service if paying out-of-pocket.
    • For "extended sessions", the cost of additional time beyond the standard "hour" is prorated based on the standard rate.
    • Initial evaluations submitted to insurance will be billed at $150/ “hour”.
    • Phone consultation,  video-conference calls, and email communication (which insurance will not pay for) and other meetings not reimbursed by insurance will be billed at $125/"hour". Payment is expected within 14 days of service.
    • Court related consultation or evaluation will be billed at $250/ “hour”, which must be paid in advance.
    • Missed meetings, not cancelled 24 hours in advance, are billed to the individual (since insurance will not pay for missed sessions) at 50% of the regular rate.
    • I currently only submit claims for Blue Cross Blue Shield of Kansas.  If you want to use BC/BS insurance from anywhere other than the state of Kansas, call the number on the back of your card before our first meeting to ask the following questions:      
    • Is Jim Kreider an “approved provider” for your plan?
    • Is an authorization or referral required before the initial meeting?
    • What is the benefit coverage (number of sessions per year, deductible, how much is covered per session, when you must start making co-payments, etc.)?   
    • How much are your co-payments (the portion of each session you will be responsible to pay)?   
    • Payments can be made by either check or cash.
    • If a balance is not paid within 90 days, you may be asked to supply credit card information (which will be stored securely).  In the event payment is then not made within 60 days, your credit card will then be billed for the outstanding balance.
    If you have insurance other than BC/BS of Kansas:
    • Full payment is expected at the time of service. 
    • If you want to submit your own claim to your insurance company to see if they will reimburse you for seeing  an “out of network provider,” I can provide a statement with the necessary information (diagnosis, service code, date of service, provider information, etc.) for you to use for that purpose.

    “How can a therapy ‘hour’ be only 40-50 minutes long???”
    • 50 minutes had been the standard for a psychotherapy "hour" for more than seventy five years, but as managed care companies have tried to reduce their costs, the therapy "hour" has been reduced to 38-52 minutes.  As a result, companies will only pay for this length session unless and "extended session" can be justified as medically necessary.

    • Why not a full 60 minute "hour"?

    *   Session "progress notes" are required to be written for each therapy meeting or "session."

    *   Insurance "claims" must be completed and filed for each therapy session.

    *   Paperwork must be completed for periodic "re-authorization" or auditing.

    “What else might be important for me to know about insurance?”
    • A mental health diagnosis must be given when insurance is used.  This diagnosis must be provided to the insurance (or managed care) company for them to “process” claims.  Your diagnosis may be stored in the Medical Information Data Bank, which is accessible to all US insurers.
    • Insurance companies make a point of stating that they do not guarantee payment for the services you receive.  A “determination” will be made once a claim is submitted and “processed”.  When making determinations, some companies may ask for chart notes and/or a review of your complete history, symptoms and therapy progress to date.  This review is conducted by one of their “case managers” or sometimes by their staff psychiatrist to “make a determination”.
    • Services must be determined to be “medically necessary” for an insurance company to pay.  Many reasons people seek counseling are not generally considered “medically necessary,” such as relationship difficulties, life changes or life stresses, losses, personal growth issues, or learning coping skills.  Only “mental health disorders” diagnosable using the Diagnostic and Statistical Manual of Mental Disorders will be considered by the insurance company for pay for services.
    • If your claim is denied, and you disagree with their determination, you can challenge their denial through the company’s appeals process.  If they continue to rule against you, you will be responsible for the full charge for services. 
    • Some people choose to “pay out of pocket” ("self-pay") to avoid these issues related to the insurance industry.

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