Using Insurance for Therapy

blue cross/blue shield

OUT-OF-NETWORK

We help clients use their out-of-network insurance benefits to cover the cost of therapy.

If you have BCBS insurance, you most likely have out-of-network benefits. You also mostly likely do not need pre-approval for a 45 or 60 minute psychotherapy session, and there is no limit to the amount of sessions you can have in a year.

Blue Cross/Blue Shield PPO

BCBS will typically cover 70% of their customary rate or allowed amount for out-of-network coinsurance reimbursements. While some plans set the allowed amount at an artificially low rate ($83 for a 45 minute meeting), other plans use the usual and customary rate ($275 for a 45 minute meeting, and $310 for a 60 minute meeting). To find out what the allowed amount for your specific plan is, please speak to your insurance company.

Here’s an example of what this looks like using the Fair Health Consumer website to calculate expenses for a 45-minute session. This is a useful tool to provide you with an estimate of your healthcare expenses.

70% of the usual and customary fee means that they will pay $175 of a $250 fee, making the out of pocket cost $75 after reimbursement. 

We have also seen out-of-network deductibles range from $1,500 – $2,800 depending on the plan.

 

Screen+Shot+2019-01-30+at+11.36.39+AM.png

 

Highmark Blue Cross/Blue Shield

Highmark BCBS will typically cover 60% of the usual and customary rate or allowed amount ($250 for a 45 minute meeting, and $300 for a 60 minute meeting).

Here’s an example of what this looks like using the Fair Health Consumer website to calculate expenses for a 45-minute session.

60% of the usual and customary fee means that they will pay $150 of a $250 fee, making the out of pocket cost $100 after reimbursement. 

We have also seen out-of-network deductibles range from $1,000 – $3,000 depending on the plan.

 

Screen+Shot+2019-01-30+at+11.38.57+AM.png

*BCBS Payer ID for electronic submissions is 00803

 

To receive an approximate estimate of what you can expect to pay for therapy, enter your information into our Insurance Benefits Calculator. You can download and email us this information and we will cross-verify your benefits on your behalf. 

In-Person Therapy Made Easy

Online Therapy Made Easy

Insurance + Billing

ADDRESS

276 5th Avenue, Suite 605,
New York, NY 10001

GET IN TOUCH
OFFICE HOURS

Monday–Thursday
7am–9pm

Friday
7am–8pm

Saturday-Sunday
8am–4pm

CONTACT US

Have a question? Ask away!
We look forward to connecting with you.

    ESSENTIAL READS
    WordPress Image Lightbox