Rates, Insurance and Cost

It can be a challenge determining if or how your insurance will pay for your treatment. The system doesn’t make it easy. But don’t give up!

We understand how difficult it can be to deal with the financials while seeking help for a mental health issue. This page will hopefully make the process a little easier.

Here are some things you should know.

1. We are an out-of-network provider

Our practitioners are not in any insurance provider networks. If your insurance plan does not have out-of-network coverage, then it won’t cover your visits with us.

That includes Medicare, Medicaid and Medicaid Managed Care Plans such as United Health Community Plan, and policies purchased on the ACA (Obamacare) health insurance exchange.

2. If you aren’t sure whether you have out-of-network coverage, here’s how to find out

Call the number on the back of your insurance card. Here are some questions to ask:

  • Do I have out-of-network benefits for mental health services?

  • Do I have a deductible for out-of-network mental health services? How much is it? What’s the remainder on my deductible?

  • What is the reimbursement rate for mental health services? (The usual rate is 50%-80%).

  • What is your approved visit cost for mental health services?

3. If your Insurance covers out-of-network visits, here’s how it usually works

Every plan and provider is different. But many plans with out-of-network coverage have a deductible, and provide reimbursement for the cost of our services.

The deductible is the amount you have to pay up front until your insurance will begin reimbursing you. When you start coming to see us, you pay for the full cost of your visits up front until you’ve met your deductible. This amount is different for every plan.

Once you hit that amount, your insurance will start pitching in. They’ll reimburse you for a percentage of the cost of your visits.

That percentage varies by plan, but usually the amount is around 50-80% of their “approved visit cost” or “customary amount” for a session. That approved amount may or may not be as much as the actual cost of the visit.

So, if your therapist charges $200 per session but your insurance plan’s approved visit cost is only $150 per session, they will only reimburse you for 50%-80% of $150.

You’re responsible for paying the difference. You’ll pay the full amount at the office, and your insurance company will send you a reimbursement check in the mail.

Each of our providers charges a different amount. Most fall within the approved visit cost for most insurance plans.

If you have a deductible, you’re responsible for paying in full for visits until the deductible is met. After the deductible is met your insurance will reimburse you for the portion of the visit cost that your particular plan approves.

4. What we can and can’t do

We won’t be able to tell you how much your insurance will cover before we file with your insurance, as every plan is different.

We also can’t tell you whether your insurance will cover your visit before we file for your first appointment and find out. Once we file, we’ll have more specific information from your insurance provider about how they will reimburse you.

We will file for you for out-of-network reimbursement with your insurer, and we may be able to answer some insurance-related questions.  Please feel free to ask, and we’ll answer to the best of our ability.

If you don’t have insurance—or your plan doesn’t cover out-of-network providers—we offer a limited number of sliding-scale openings on a case-by-case basis.

Call 212-621-7770 for more information about our sliding scale, or get in touch https://www.mindbody7.com/contact-us/ to find out more.

 

 

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