Session Pricing for
Concierge Therapy Practice

-Emotional Support Animals Upon Request 
-Patient's favorite snacks and drinks on site at all times

Sliding Scale Pricing

INTAKES (Assessment, Biopsychosocial, Initial Visit)

Individual Intakes- $400

Family/Couples Intakes- $600

Therapy and Medication Intakes with Nurse Practitioner and Psychotherapist- $650 

Medical Marijuana Intake- $350 for new patients, $275 for returning or current patients.

*Must meet with psychotherapist and nurse for evaluations and diagnosis.* *Continued psychotherapy is suggested, post diagnosis.*

 

 

NURSE PRACTITIONER FOLLOW-UP SESSIONS

$250

 

MEDICATION-PSYCHOTHERAPY SESSIONS

*At least one 30-minute psychotherapy session must be completed monthly to continue medications.

Monthly 30-minute psychotherapy session- $200*

 

PSYCHOTHERAPY SESSIONS

Couples and Family Sessions increase an additional $50-$100 depending upon the amount of members attending.

Two Psychotherapy Sessions Per Week- $175 per session

Weekly Psychotherapy Sessions- $225  per session

Two Psychotherapy Sessions Per Month- $275 per session 

Monthly Psychotherapy Sessions- $325 per session

 

 

GROUPS

Adolescent/Teen Heal Yourself Group Therapy

- 2 sessions per week

- $100 for the week

Adult Heal Yourself Group Therapy

- 2 sessions per week

- $150 for the week

Family Heal Yourself Group Therapy 

- 2 Sessions per week

- $200 for up to 3 family members for the week, $50 each additional family member

 

Group sessions are billed at the beginning of every week for the week. If you miss a session homework and videos will be provided so you do not fall behind. 

 

Missed Sessions without 24 hours notice, billed $75.

Repeated cancellations switched from weekly to a bi-monthly schedule.

 

Travel, Home Visits, and Environmental Sessions

Additional $100-$200 fee per session depending on location distance

Travel Reimbursement $2.50 per mile



Packages

6 Psychotherapy and Skill Training Sessions with Conceirge Texting with your Psychotherapist

$1,100+ reduced $300 intake fee= $1,400

Can be spread out does not have to be weekly

This includes a brief assessment, and 4- 60 minute sessions of psychotherapy and skill training to decrease undesired/unskilled thoughts, behaviors and emotions.

You will be provided with training worksheets and homework to keep up with your skills and processing upon completion of session 1.

Packages must be paid in full upon admission

12 Psychotherapy and Skill Training Sessions with Conceirge Texting with your Psychotherapist

$2,200 + reduced $300 intake fee= $2,500

Can be spread out does not have to be weekly.

This includes a brief assessment, and 10- 60 minute sessions of psychotherapy and skill training to decrease undesired/unskilled thoughts, behaviors and emotions.

You will be provided with training worksheets and homework to keep up with your skills and processing upon completion of session 10.

Packages must be paid in full upon admission

How to file for insurance reimbursement for therapy. 

Conceirge portions such as travel time, mileage reimbursement, and texting are not covered by insurance, all others can be depending on your out of network provider benefits.

Filing for reimbursement for psychotherapy is actually very simple! You can do it online, or by mail. Here’s how.

Most of the more skilled and experienced psychotherapists are “out of network” providers, meaning you’ll pay your therapist directly, and then submit a claim for reimbursement to your insurance company.

 

More about getting fair and accurate reimbursement is below this portion. 

 

FILING YOUR CLAIM ONLINE

It’s very likely that you can file your claims for reimbursement online, on your insurance company’s website.

  1. Sign in to your account on your health insurance company’s website.
  2. Find “Submit a claim online”.
  3. Fill in the info they request.
  4. Scan and upload a copy of your psychotherapist’s bill.

That’s it!

Here’s the info they’ll request – all of this will be on the statement your therapist gives you:

  • Provider’s name and address
  • Provider’s tax ID number (might be TIN, EIN, FEIN, or SSN)
  • Diagnosis code (“ICD”) – for example, “F41.1” for Generalized Anxiety Disorder
  • Procedure code (“CPT”) – for example, “90837” for Individual Psychotherapy, 60 minutes
  • Telehealth modifier is a (-95), after the CPT code

Here’s an example of a page from an online claim, showing some claim information filled out, and the button you’d click to attach a copy of your therapist’s bill:

 

 

 

 

 

FILING YOUR CLAIM BY MAIL

If you aren’t able to file your claim for reimbursement online, you’ll fill in a paper claim form, attach a copy of your therapist’s bill, and mail it to your insurance company.

You can find the claim form on your insurance company’s website, where you can print it out. (Some insurance companies use a different claim form for psychotherapy – it might be called a “behavioral health” claim form.)

 

Helpful Hint: Since you have already paid your psychotherapist, and you’re filing for reimbursement, write in bold letters (and highlight) on the claim form, “PATIENT HAS ALREADY PAID PROVIDER – PLEASE REIMBURSE PATIENT”. This is already done for you on the forms provided to you to submit with your company's form for reimbursement.

Diagnosis. You’ll enter this as a code, which will be provided to you in an e-mail by me upon request.

Place of service. For psychotherapy it is either in my office, the code will typically be “Office,” which is code “11", or if done via tele-health will be indicated after the CPT code with a "-95" modifier.

Description of Services, or CPT. “CPT” is the code for what kind of service your therapist provided, and should be on your therapist’s invoice. For example, “Individual Psychotherapy, 60 minutes” is “CPT 90837.”

My NPI number. It is on the printable patient invoice I e-mail to everyone. 

My signature. If necessary, by your insurance company, please e-mail me to attach it to your final filled out claim form.

Assignment. Don’t sign anything that says “authorize assignment”, since you’ve already paid your therapist and are filing for reimbursement. If you authorize or assign your benefit, that means the insurance company will send payment to your therapist instead of you.


 IF YOUR INSURANCE COMPANY IS "OLD SCHOOL"

The universal insurance claim form is called a HCFA (“HICK-fah”) form, or CMS-1500 form, and a sample one is shown below.

How to fill out a HCFA / CMS-1500 to get reimbursed for psychotherapy

If your insurance company requires you to fill out a HCFA or CMS-1500 form, here are box-by-box instructions.

Box 1: Check “Group Health Plan” if your health insurance is through your employer, or the Affordable Care Act (“Marketplace”).

Box 1a: Enter the ID# printed on your insurance card.

Box 3 and 5: This is your information.

Box 4: If you’re the policy holder, enter your name here. If you have insurance through a parent’s or spouse’s policy, enter their name instead.

Box 6: Your relationship to the insured. Check “self” if your insurance policy is in your own name.

Box 7: Your address and phone, or if the insurance is through someone else, such as a spouse or parent, enter theirs.

Box 8: Check the boxes that apply.

Box 9: This is only used if you have multiple insurances.

Box 10: The answers to these questions are all typically “no.”

Box 11: Group number, found on your insurance ID card.

Box 11a: Your date of birth, or if the insurance is through someone else, enter theirs.

Box 11b-c: You can leave these blank.

Box 11d: Check “No” if you only have one health insurance policy, If you have two insurances, check “yes” (and see Box 9).

Box 12: Sign and date.

Box 13: Don’t sign this box, since you’ve already paid your therapist and are filing for reimbursement. Otherwise, the insurance company will send payment to your therapist instead of you.

Boxes 14-20: Leave blank.

Box 21: Enter the diagnosis code(s). This should be on your therapist’s invoice, and it’ll be a code that comes after “ICD” — for example, on the invoice it’ll probably say something like “ICD-10: F41.1”, in which case you’d just write the code “F41.1”.

Box 22: Leave blank.

Box 23: Leave blank, unless you had to get a prior authorization to see your therapist.

It’s best to include just one psychotherapy session per line, so:

Box 24a: Date of service (same date for “from” and “to”)

Box 24b: Place of service. For psychotherapy in your therapist’s office, the code will typically be “Office,” which is code “11.”

Box 24c: Leave blank.

Box 24d: “CPT” is the code for what kind of service your therapist provided, and should be on your therapist’s invoice. For example, Individual Psychotherapy, 45 minutes is CPT 90834.

Box 24e: Leave blank.

Box 24f: The amount your therapist charged.

Box 24g: Units – in this case “1”, since you’re entering one session per line.

Box 24h: Leave blank.

Box 24i: Leave blank.

Box 24j: Your therapist’s NPI number, if they have one. If they don’t, the insurance company will still process your claim; just write “none” here.

Box 25: Your therapist’s Tax ID number (EIN) or Social Security number (SSN).

Box 26: Leave blank.

Box 27: Check “No” since you’ve already paid your therapist and are filing for reimbursement.

Box 28: Total of all charges listed in Box 24 above.

Box 29: Amount you paid.

Box 30: Leave blank.

Box 31: Fill this in with “See attached invoice.”

Box 32: Leave blank unless you were seen at a clinic.

Box 32a: Leave blank.

Box 33: Your therapist’s phone number and address.

Box 33a: Your therapist’s NPI number (see 24j above).

Receiving Fair and Accurate Insurance Reimbursement

Step 1: Become informed

Insurance companies have some interesting ways to determine coverage. Plans don't often say they will pay 80% of the cost for an out of network psychotherapy appointment — it’s 80% of what they say psychotherapy costsThat’s an important number.

They use something called Usual, Customary, and Reasonable (“UCR”),  reasonable market value, generally a number they make up. They may also use a percentage of the Medicare rates as the basis for how much they’ll pay — even if you aren’t eligible for Medicare.

Keep in mind that they use that number — what they say psychotherapy costs — to calculate your reimbursement. 

 

Example: If your insurance plan says it covers 80% of psychotherapy fees, what that really means is they’ll pay 80% of what they say the typical fee for psychotherapy is.

Unfortunately, there are very few regulations for how they determine that number. And, they usually won’t tell you what that number even is — calling it “proprietary information.”

Good news, though! 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 for a specialist like me. Also having a specialist like me that is trained in many approaches other therapists are not will likely increase your chances for higher reimbursement rates!

The Fair Health Consumer, can be used to look up typical Provider Charge (Fair Health’s term for UCR) for psychotherapy in your area:

  •  
    1. Enter the Zipcode of my office 19802
    2. Click the Behavioral Health option
    3. Click the procedure code either 90837 which is the procedure code for individual outpatient psychotherapy, 60 minutes; or your initial intake appointment is code 90791, which you can simply type into the CPT code search bar on the home screen
    4. Side by you will see reimbursement for In-Network and Out ac

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.

2. Call your insurance company

When you call, they’ll first let you know what your insurance plan covers in general terms — for example, 80% of “the UCR.”

Example: If your insurer considers $200 to be the UCR for psychotherapy, and you have 80% coverage, they’ll cover $160.)

Ask about what to expect for reimbursement for psychotherapy. 

Tell your insurer this information:

  •  
    • You’ll be submitting claims for “Individual Psychotherapy, Outpatient, 60 minutes,” also referred to as CPT code 90837.
    • My current fee schedule is a sliding scale, so know your fee based on your decided plan- for CPT code 90837 I charge $175 per session if you are doing two sessions a week, $225 for weekly sessions, $275 per session for sessions twice a month, and $325 for psychotherapy once a month .
    • My Zip code is 19802 (reimbursement varies based on location).
    • I’m a licensed associate counselor, and I’m a non-participating provider (meaning I’ve chosen not to have a “contract” with any insurance companies).

Then ask them if your therapist’s fee is within the range of what they use to determine reimbursement. If they say anything, they’ll typically only say either “yes” or “no”.

If they say no, or that they can’t tell you that, you can tell them you’ve used the Fair Health Consumer site to look up the Typical Provider Charge for psychotherapy in your area, and that the amount is $200 per psychotherapy session and $467 for initial evaluation. Then ask them if that figure is what they use to determine reimbursement — and if not, "Why?!?"

3. Ask your psychotherapist for help and guidance

Clearly, insurance companies prefer keep things to their advantage, not to patients, and all therapists are aware of this. Thats why most expert therapists choose to stay out of partnerships with insurance companies.

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