What is a deductible?

Most insurance plans will have some kind of deductible. If you have one, this means you may have to pay for your sessions at the allowed rate of your insurance company until your deductible is met. Each insurance company decides what they are going to pay our office, Center for Psychological Well-Being (CPW), so your expense will vary depending on your individual insurance plan, and be based on your insurance company’s allowed amount.

CPW will provide you, via email and prior to your first session, an estimate of what your typical out of pocket expense will be per visit if your particular plan requires you pay the deductible. Once your deductible has been met, this will change, and you will then either have a co-insurance, a co-pay, or be covered in full for the rest of the calendar year, depending on your plan. Of course, these rates are subject to change and are not a guarantee, and the only guarantee of benefits is when we receive an explanation of benefits from your insurance company detailing the “patient responsibility.” Most often, you will receive your explanation of benefits prior to us receiving it.

What is a copay? What is co-insurance?

Certain plans only have a flat copay or coinsurance rate and do not apply your sessions toward your deductible. If your insurance does apply sessions toward your deductible and your deductible has already been met for the year (deductibles reset at certain times of the year depending on your plan, usually the first of the calendar year), then you may only owe your copay or coinsurance. A copay is a set dollar amount for a particular service, and coinsurance is a percentage of the allowed amount the insurance will pay. So, depending on your copay/coinsurance, the amount you pay out of pocket can be different for mental health services compared to seeing your medical doctor.

Should I contact my insurance company?

While we make every effort to provide you with the necessary cost information prior to your first appointment, the rates we provide are only an estimate. If you want to know a more precise cost, we encourage you to contact your insurance company prior to scheduling an appointment and asking what your “out of pocket” cost will be for “outpatient mental health services.” Keep in mind, this is also an estimate, and insurance company representatives may not always give you accurate information. Typical therapy visits at our office fall under “outpatient mental health services.”

Specialized evaluations completed at our office, however, have two parts: the interview portion with the psychologist is considered an outpatient mental health service; however, the psychological testing portion is a different benefit category and often goes toward your deductible, if you have one. Feel free to contact our office by emailing info@cpwpsych.com if you would like us to provide you the codes used for billing any of our services to make your call to your insurance provider easier.