Fees & Insurance
Many patients file for reimbursement through insurance coverage, and the vast majority are reimbursed more than 50% of costs.
Contact me for fee information if needing a psychological evaluation.
Like many experienced psychologists and psychotherapists in New Orleans, I don’t take insurance directly. Patients pay me, and then file for reimbursement from their health insurance, should they elect that option. Many of my patients file for reimbursement, and the vast majority are reimbursed more than 50% of my fees. If you decide to submit a claim for insurance reimbursement, I’ll gladly help.
If you haven’t filed an insurance claim yourself, rest assured that my patients routinely find that the process is much simpler than they thought it would be — plus, I’ll help guide you through the process.
If interested in market rates for psychotherapy or other medical services, consult the Fair Health Consumer.
Insurance filing information
Insurance companies use elusive ways to determine what they’ll cover. If your plan says it’ll cover 80% of the cost of psychotherapy, that means they’ll cover 80% of what they deem Usual and Customary (UAC), not the rate charged by the therapist or psychologist. The UAC is an important number. Often this amount is based on a percentage of Medicare rates.
The catch is your insurance company usually won’t tell you what that number even is, calling it “proprietary information.”
Some good news: Thanks to numerous class action lawsuits, and legislative work on healthcare laws, there’s a consumer rights website where you can see what an objective source says the typical fees are in your area.
The site is Fair Health Consumer, and here’s how to use it to look up the Typical Provider Charge (Fair Health’s term for UCR) for psychotherapy in your area:
- Enter the Zip code of your therapist.
- Enter the procedure code; 90834 is the procedure code for individual outpatient psychotherapy, 50 minutes, or you can ask your therapist what code they’ll use.
- Click “See Out-of-Network Reimbursement”.
- Scroll down to “Cost Breakdown” (ignore the first few rows you see on the page — those includes other charges like hospitalization).
There you have it! Now you know the real typical cost for psychotherapy in your area, and you’re armed and ready to call your insurer.
Ask for a description of your benefits including your deductible and coinsurance rates (i.e., percentage they pay and percentage you pay). Remember, that percentage is based on Usual and Customary rates, not the Psychologist’s actual fee.
Ask about what to expect for reimbursement for psychotherapy. For example, if you were to call about reimbursement for psychotherapy with me, you’d tell your insurer this information:
- You’ll submit claims for “Individual Psychotherapy, Outpatient, 50 minutes,” also referred to as CPT code 90834.
- CPT code is 90834 and my rate is $175
- The provider zip code is 70115 (reimbursement varies based on location).
- The provider is a licensed psychologist, and a non-participating provider (meaning I do not to have a “contract” with any insurance companies).
Then ask them how the fee compares to what they use to determine reimbursement. It’s highly likely they won’t be able to tell you.
Insurance companies prefer to skew the “game” to their advantage, not to patients, and most therapists and psychologists are aware of this. Therapists should also be able to help if insurance companies aren’t playing fair, and guide you about the ins and outs of getting the reimbursement you’re due.
Like many healthcare providers, my patients pay me my fee directly, and then file for reimbursement. If my patients run into any snags, I’m there to help and guide them, whether it’s with CareFirst, United HealthCare, Aetna, Cigna, or any other insurance carrier.
Having had more than two decades of experience with helping patients get the reimbursement they’re due, I’m skilled at it, know the ins and outs, and am glad to help my patients get the full amount of reimbursement they’re actually due.
