Rates & Insurance

• Initial Intake Appointment, 60 minutes: $250

• Individual Therapy Session, 50 minutes: $200

• Assessments and Evaluations (ADHD, ASD, Comprehensive Clinical, & Immigration): $300 - $2,000 (depending on type of service)

A Good Faith Estimate is made available to all clients at Intake.

Here are key questions to ask your health insurance company about out-of-network benefits:

Coverage and costs

• Do I have out-of-network benefits (ONN)? Many plans, like Exclusive Provider Organizations (EPOs) and Health Maintenance Organizations (HMOs), may not offer coverage for non-emergency out-of-network care.

• What is my out-of-network deductible? This is the amount you must pay out-of-pocket for out-of-network care before your insurance starts to cover a portion of the costs. Be aware that this is usually separate and higher than your in-network deductible. Knowing your deductible will allow you to know how much money you will have to pay out of pocket before your insurance begins to cover sessions fully or require you to pay a copay. Finding out how much you’ve already spent will let you know how much more you need to spend in order to meet your OON deductible. For example, if your OON deductible is $1,000 and you’ve already spent $850, you will only need to spend $150 more before your OON benefits kick in.

• What is my out-of-network coinsurance? This is the percentage of the cost you are responsible for after meeting your deductible. For example, your plan might cover 80% of in-network care but only 60% of out-of-network care. Once you’ve met your deductible, you might pay 20% of the cost of the health service or procedure, for instance. Your insurance company would pay the balance.

• Does my plan use an "allowed amount" for out-of-network services? Your insurer may cap how much it will pay for a service. If the provider charges more than this "allowed amount," you are responsible for the difference, which is known as "balance billing".

• Is there an out-of-pocket maximum for out-of-network care? For plans that cover out-of-network services, find out if there is a cap on how much you have to pay in a year. Some plans may not have a limit, leaving you vulnerable to significant costs. 

Procedure and claims

• Do they cover counseling services? There are times depending on the policy that your insurance will have a different system and/or deductible for Mental Health Out-Patient services. Ask if they cover code 90837 or 90834 (for individual counseling only).

• Do I need a referral or pre-authorization for out-of-network services? Some plans require a referral from a primary care physician (PCP) or an approval from the insurance company, even if you have out-of-network benefits.

• Does the No Surprises Act apply to my situation? The federal No Surprises Act protects patients from surprise balance billing for emergency services and certain other care, but it does not cover situations where you voluntarily choose an out-of-network provider.

• How do I submit claims for reimbursement? If you have out-of-network benefits, you typically pay the provider upfront and then submit a claim for partial reimbursement. Ask for a "Superbill" from your provider, which includes all the necessary information, and find out the correct procedure for submitting it to your insurer. Joyful Journey Counseling & Consulting, PLLC. only submits claims for in-network covered services. I am happy to provide a Superbill for all OON services I provide.  

• What is a Superbill? A superbill is a document your therapist will provide to you that will include dates of service, a diagnosis code, a CPT code, and your therapist’s NPI and EIN numbers. It is really important to ask this when speaking with your insurance representative as each insurance company has different procedures when submitting a Superbill.  

• What is the deadline for submitting claims? Insurance companies have a time limit for claim submissions, which may be 90 to 180 days from the date of service. 

Submitting Superbills to your health insurance carrier can be made simple by using Mentaya (see below)!

Specific situations

• What is covered if I am traveling or away from home? If you travel frequently, check how your plan handles non-emergency out-of-network care outside your typical service area.

• Are there circumstances where an exception might be made? In some cases, if there is no in-network provider available in your area with the required expertise, your insurance company may agree to apply in-network benefits to an out-of-network provider.

• How are emergency services covered? For true medical emergencies, most plans will cover services at an in-network rate, but you should confirm what your plan considers an emergency. 

Before you call

To ensure you get the most accurate answers, have the following information ready:

• Your insurance ID card.

• The full name, National Provider Identifier (NPI) number, and tax ID of the out-of-network provider you plan to see.

• The specific service or procedure (including any CPT codes if you have them) you are considering.

• The date you plan to receive the service, as out-of-pocket costs can reset with a new policy year. 

Keep your mental health information completely confidential by choosing to private self-pay for your sessions with me!  When you pay directly for your therapy services there is no requirement for me to assign a mental health diagnosis that will forever be on your record and reported to your health insurance company.  

• Choose self-pay to eliminate sharing sensitive information with insurance companies!

• Choose self-pay to keep you in charge of your mental health care! Insurance companies often dictate how many sessions you are authorized to have, how long each session must be, not to mention, what your diagnosis MUST be (rather than what we both agree on- if any at all)!

• Choose self-pay to ensure your Protected Health Information (PHI) is not shared with any entity for reasons related to your payment for service.

I am an In Network (INN) for Aetna & MOST BCBSNC!

Be sure to check you benefits to verify what your behavioral health benefits and coverage are before your first appointment.

I provide out of network (OON) coverage for clients insured by some insurance companies.  

Be sure to check you benefits to verify what your behavioral health benefits and coverage are before your first appointment.

Sometimes, if your insurance company doesn’t have any in-network therapists who meet your needs, they can make a special exception. This is called a network gap exception or a single-case agreement. You call your insurance company and explain why you can’t find an in-network provider. You can ask them to cover sessions with me at your in-network benefit level. Sometimes they’ll ask me for paperwork too. It’s not guaranteed, but many patients are successful when they explain clearly what they need.

What Patients Can Say When Calling Their Insurance:

1. Call the number on the back of their card (Provider or Behavioral Health line).

2. Tell: 

   • “I need a network gap exception or a single-case agreement for therapy services.”

   • “I cannot find an in-network provider within ___ miles who specializes in ___.”

   • “I have contacted X# (contact up to 5 local-to-you providers) providers and either they are full, too far, or do not treat my condition.”

3. Ask (be sure to ask them for their name and a case reference number for every health insurance customer service representative you speak to):

   • “What is the process to request a network gap exception?”

   • “What paperwork do you need from me or my therapist?”

   • “While I’m waiting, can you confirm if I’ll be reimbursed at the in-network rate?”

4. Let me know what they ask for from me — I can provide a letter of medical necessity if needed.

Unfortunately, I am not in network to bill Medicare plans.  Medicare has very strict rules that do not allow providers to accept a patient's private health insurance independently from their Medicare coverage.  Medicare laws also require anyone who carries this health coverage, but who does not wish to use the coverage for a coverable service (e.g., individual outpatient therapy), must enter into a signed agreement with the provider that neither of them will submit a claim for reimbursement.  Therefore, you will be responsible for the full out-of-pocket fee without the possibility of reimbursement from your insurance provider(s).