Good Faith Estimate Notice (No Surprise Act effective 1/1/22)
Clients have the right to receive a “Good Faith Estimate” explaining how much their medical and mental health care will cost.
Under the Consolidated Appropriations Act of 2021 (also known as the No Surprise Act), the United States federal government requires health care providers to give clients who do not have insurance — or who choose not to use insurance for privacy reasons — an estimate of the bill for health care services.
Clients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. Clients can ask their health care provider, and any other provider they choose, for a Good Faith Estimate before they schedule a service. This is provided to current clients of Everson Psychotherapy, Inc. in their Agreement and Informed Consent document when starting therapy and each January of the calendar year.
For Good Faith Estimates, please note that Everson Psychotherapy, Inc. has an Employer Identification Number (EIN) of 86-2057288 and Michael Everson, LMFT has an National Provider Identification (NPI) of 1639574015. For transparency and so you might be able to know what costs you typically would need to pay for services with Everson Psychotherapy, Inc., please note that CPT Code 90791 for an Initial Psychotherapy Intake Evaluation is $150 per 45-minute intake session, CPT Code 90834 Psychotherapy is $135 for a 45-minute session, CPT Codes 90837 Psychotherapy is $200 for a 53-75 minute session, and CPT Code 90846/90847 Conjoint Psychotherapy is $135 for a 50-minute session.
If Everson Psychotherapy, Inc. and Michael Everson, LMFT is an out-of-network provider for client's insurance or clients choose not to use their insurance we shall provide a Good Faith Estimate in their Agreement and Informed Consent document when they start therapy and each January for current clients. In addition we inform referrals or clients that lower cost care may be available through an in-network provider through their insurance.
If clients receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Clients are to make sure to save a copy or picture of their Good Faith Estimate.
For questions or more information about client's right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the U.S. Department of Health & Human Services at (800) 368-1019.
Paying for Therapy
Everson Psychotherapy, Inc. offers private pay with their typical rate of $135 per 45-minute session (with the initial intake 50-minute session rate of $150). We accepts cash, check, Visa, Master Card, Discover, American Express. We can also take Health Savings Account (HSA) or Flexible Spending Accounts (FSA) cards that have a Visa or Master Card logo. Credit/debit cards must be used for Telehealth.
We also take some Employee Assistance Programs (EAPs) and Behavioral(Bx)/Mental Health Insurances.
As of 1/2/2022 we are In-Network with:
|ComPsych EAP and Bx Health Ins |
Charles Nechtum and Associates EAP
Centerstone Military Services
|HMC Healthworks Bx Health Ins |
TriCare West (HNFS; Active Military) Behavioral Health Insurance
VA/TriWest Veteran's Community Care Network (CCN) Program
Note: We are sad to say, but as of December 10, 2021 we no longer provide services using CA Victim of Crime because of their added regulations and slow payment process. If you are attempting to use that service we can discuss our reasons and see if we can be of help in another way.
If your insurance carrier is not listed above, you can check to see if your insurance would reimburse you their rates toward our typical fees for Out of Network (OON) care. If so, we can provide what is called a Super Bill after paying to turn in with your OON paperwork to request reimbursement.
Below is information to consider when deciding to pay out of pocket, using insurance, or attempting to be reimbursed by insurance for Out of Network care.
Tips for Paying Out of Pocket
It helps to know what to expect. In Sacramento, if you want to see a skilled, experienced, licensed therapist, you should generally expect to pay around $140 per session for weekly therapy - and typically more as with a more skilled professional. The average rate statewide in 2015 according to a California Association of Marriage and Family Therapist report was $146.86 (see reference link at end of page for study).
When budgeting for therapy, you should generally expect to meet once weekly with your therapist (minimum) and you should plan to incorporate this expense into your monthly budget for three months or longer. You can use a Healthcare Spending Account (HSA) or Flexible Spending Account (FSA) to use pre-tax dollars to pay for therapy (these are awesome pre-tax/tax saving benefits if you can use them or plan to use them each calendar year). Psychotherapy can also count toward your medical expenses on your income taxes, although usually your total annual healthcare expense typically must exceed a certain percentage of your adjusted gross income to receive a deduction (please consult your tax advisor to clarify).
If you need a reduced fee, always ask. Even experienced therapists most often offer sliding scale rates based on income or ability to pay.
For further reduced rates, you might consider seeing a skilled pre-licensed or newly licensed therapist. These clinicians generally offer a lower sliding scale and you can expect fees to range from approximately $40 to $90 per session. We'd be glad to recommend highly skilled Associate MFTs (finished with graduate school and well into working on their 3000 hours under a licensed clinician) or MFT Trainees (in their last semesters of graduate school also under supervision) that we are aware of.
Using Health Insurance to Pay for Therapy Services
Dealing with health insurance companies can be frustrating for both the client and the therapist. We know first hand on both sides of the being the therapist and the being a client. We totally understand wanting to use a service that many people pay high premiums monthly for said benefits. Unfortunately, many therapists choose not to take some insurances as they find that insurance agencies will reduce the therapist's usual and customary fee, delay reimbursements, provide burdensome paperwork, restrict/limit the amount of treatment, or limit the amount of therapists to be approved on their in-network panel. Here is some information so you can be as informed; this information can be general so please consult your insurance representative for the most accurate information based on your plan(s).
Limitations of Coverage
Many insurance companies will only authorize services that they believe are “medically necessary.” Most health insurance plans require ongoing paperwork and justification for therapy, at times approving only a certain amount of sessions at a time before more justification, paperwork, and time is required for re-authorization. It is important to understand that neither you nor your therapist determine the length or frequency of your psychotherapy - that’s up to your insurance carrier. As well, some insurances will not cover relationship (couples or family) therapy because they consider it a relational therapy versus “medically necessary.” Be sure to understand what limitations are found in your insurance.
In order to justify your treatment, your therapist must provide your insurance company with a mental health diagnosis and sensitive personal information about your therapy which will go into health insurance files that can be accessed by numerous gate keepers, utilization reviewers and other employees.
If you and your therapist have in the back of your minds that what you are saying/doing in therapy can be discussed with your insurance company and effect whether your treatment is covered, then everyone can be "on guard" in the therapy sessions. Such a climate is counterproductive for the success of your therapy because for therapy to work, you need to feel you can be honest, vulnerable, and speak freely.
In addition, your mental health diagnosis and treatment records may count against purchasing things like self-employed private insurance or life insurance coverage as it become part of your general medical record.
Restricted Choice of Providers
The provider restrictions differ for PPO/POS plans and HMO plans, and are described below.
PPO or POS Plans
If you have a PPO or POS plan, you tend to have the most flexibility and are fortunate. You can either choose a therapist from the “Preferred Provider” or in-network list of your health insurance company, or you can choose an out-of-network therapist. The reimbursement rate typically will be higher if you choose from the in-network panel and could be lower if you choose an out-of-network provider (someone not contracted with them).
One caveat to consider is that PPO plans tend to reimburse based on what they call “usual & customary” fees. But the insurance plan determines what fees are “usual & customary” and generally these fees are not representative of actual psychotherapy fees. From the same survey noted above, in 2015 the average reimbursement was $101.81 in the state. Despite that quoted average, many well known insurance companies have been paying well under that rate in the Sacramento area and what we have seen from colleagues taking from some well-known insurers tend to be more like $66 to $86 reimbursements.
For example, an insurance company may determine your benefit for therapy with an LMFT at a "usual & customary" fee of $80 per session and pay some percentage of this fee. The problem is that in Sacramento, or the average rate for the state in general, a fee of $80 is neither usual nor customary. As noted above, an actual LMFT’s fee will average around $145 per session. If your PPO plan pays 50% of each session, they’ll do this based on the “usual & customary” fee that they determine. So in this example, instead of paying 50% of the rate you are charged (i.e., let's go with a fee of $130), the insurance plan will reimburse $40 per session (50% of $80, their “usual & customary” fee) and you will be responsible for paying the remaining $90 per session. If their usual and customary fee is even lower, you pay more.
PPO plans will also sometimes reimburse up to a covered rate by accepting a Super Bill from an out of network licensed therapist (very rarely are pre-licensed therapist fees reimbursed). In this scenario, you would pay the therapist their typical fee and they would give you a Super Bill that gives the insurance company information they need to determine if they will reimburse you per the plan’s agreement for out of network therapists. Again, you’d want to talk with an insurance representative to see about that possibility.
If you have an HMO plan, more often than not you are required to choose a provider who is on your insurance panel. Keep in mind qualified therapists may be choosing NOT to participate on managed care health insurance panels or are severely limiting their participation because the reimbursement rates can be low, the paperwork time consuming, the coverage limited and tightly managed, and the involvement of the insurance company can make it difficult for both you and your therapist.
Finding an effective therapist who is the right fit for you is hard enough. Finding one on your insurance panel may be even harder and will likely require some effort on your part, which can be frustrating and disappointing. It’s worth the effort though, because seeing an ineffective therapist can make problems worse and leave you feeling more hopeless and disheartened.
Tips for Choosing a Therapist Covered by Your HMO
If you prefer to or simply must use your HMO insurance, you can request a list of providers through your insurance company. An online list of providers is often available. Once you obtain this list, it is suggested that you ask friends, your physician or a therapist whom you respect to recommend providers on the list. Some of the providers on the list may also have websites where you can learn more about them and see who appeals to you. When you meet with a therapist on your insurance panel, or any therapist for that matter, ask questions and only go back if it feels like a good fit.
More and more insurances have deductibles you must meet prior to any benefit kicking in and these deductibles are usually annually reset. It is always important to know how much you must pay into a deductible before the insurance company will start to provide the benefit they state they offer. For example, if one’s insurance state they will pay 50% of the usual and customary rate after the insured person's $1000 deductible is met, that means you must first pay the full contracted fee of your therapist until you hit that $1000 cap before the insurance starts to pay anything toward those fees. If you don’t secure what your deductible is and your therapist is not paid by the insurance agency because of this deductible, you are responsible for previous incurred fees.
Most couples/marital/relationship therapy will not be covered by most insurance carriers as they often do not consider relationship therapy as "medically necessary." Insurance work from a medical model, meaning they usually need some sort of medical diagnosis to reimburse for therapy (e.g having a mental health disorder dealing with mental health issues of depression, anxiety, bipolar, etc.). As well, if there is a mental health disorder that is affecting the relationship, the person having that mental health disorder must be the covered client. For example, if one partner is dealing with depression and the therapist found that it is affecting the couple, the therapist could bill for that mental health medical disorder but only if that partner was the one who was covered by the insurance. If each partner has different insurances that also gets complicated. Again, you'd want to check with your insurance providers to see how and if they cover relationship counseling.
Insurance Bottom Line
Before opting to use your insurance, you will want to check to see if you must see an in-network therapist, if you can be reimbursed for an out-of-network therapist, how many sessions would be covered by your insurance plan, what deductibles you must meet, what the coverage percentage of reimbursement is, and what co-pay or co-insurance rate you must pay to make sure that using your insurance feels worth your while. You want to evaluate whether the actual financial benefit outweighs the downsides of compromising your privacy, choosing a limited coverage that may not meet your treatment needs, and perhaps most importantly, restricting your choice of providers.
Some people elect to forgo using their insurance because they find that the limitations outweigh the benefits. They choose to incur the out-of-pocket expense for therapy to ensure their privacy as well as to ensure that they are with a skilled therapist of their choosing for as long as they determine their treatment is needed.
PS - Answering a common question: Why do therapists charge "so much?"
One last thing we can offer is an attempt to answer a question that sometimes people ask of "why do therapists charge so much?" People might even think things like, "man, if I made my therapist's rate per session I'd be rich." Yet there are many costs that play into the therapist's fee that can help one understand that the fee charged is not close to what the therapist actually makes. As well, many therapists take a range of fees, sometimes offering some sessions at a reduced sliding scale, other sessions through temporary reduced EAP contract fees, and keeping some spaces open to lower or pro-bono fee clients. A blog from PsychCentral clarifies more of what goes on behind a therapist's development of their typical fee. To learn more, please go to https://psychcentral.com/blog/why-do-therapists-charge-so-much/
What We Can Do To Try To Help with Fees and Insurance
We are happy to talk to you more about what may be possible. Currently Everson Psychotherapy, Inc. is paneled with the above mentioned EAP and Behavioral Health Insurances. If you have a In-Network EAP/Insurance we take, we are happy to call on your behalf to understand your deductibles, co-pays, co-insurances, and other information to help you understand your costs (please note: ultimately it is the client's responsibility to understand their insurance and fees but we are willing to help walk you through sometimes challenges insurance companies provide to figure that out). We also have a small sliding scale based off of your household income that at times may help reduce our typical fee. Ultimately Everson Psychotherapy, Inc. was developed to help people and provide a living. Despite the need to provide for our families, we make efforts to keep our regular fees even lower than most therapists with similar or even less skills and training than we provide, reduce our fees when we can based on income, offer options to see us through some insurances/EAPs, offer some spaces to very low paying to pro-bono when we have space, and provide contacts and referrals to other therapists that can provide even lower fees than we charge. Mike's being a client on the couch himself both with his own therapy or with medical doctors makes him understand the challenges and frustrations of finding care in our health system. Please feel free to talk with us so we can be of help to find resources on how to help you irregardless of cost factors. Our main desire is to find help for those that are searching, so if we can do that even if we don't become your agency that provides you therapy, we're happy to be of help.
**CAMFT Study noted above: https://www.camft.org/images/PDFs/articles/mariam/2015_demographic_survey.pdf