Karen's Fees are private pay, out of network provider for all insurance plans.
Clients are required to pay my full session fee at the time of service:
$170 for on-going 50 minute sessions
$200 for Couples and families and 60 minute sessions
Utilizing out of network insurance benefits:
I am no longer be a contracted in-network provider with any insurance company. This is a decision I have not made lightly, but one thoughtfully guided by my personal values, frustrations with insurance companies, and my ethics as a licensed therapist. I am including a link to an article that explains some of the challenges and solutions of being in network provider with insurance companies as an LMHC https://medium.com/@karen_90828/ten-reasons-why-your-mental-health-provider-stopped-or-never-started-taking-your-health-insurance-4d7f23236483
There are both benefits and challenges to seeing an out-of-network provider. First it removes a third party from having any say in your therapy services. It allows you and I, together, to make autonomous decisions about what type of therapy you receive, how long your sessions are, and the duration you wish to stay in therapy. Importantly, no longer contracting with insurance companies allows me to better ensure your privacy. Diagnosis information, notes from our meetings, and treatment plans are no longer readily accessible to your insurance carrier. I’ll no longer be required to give you a diagnosis, unless you need a Superbill for out of network (OON) benefits. This is especially relevant for those of you seeing me for issues related to relationship counseling or grief and loss (both common human conditions that don’t meet criteria for a “diagnosis”). I’m hopeful you and I will get to continue our work together with an enhanced sense of privacy, flexibility, and autonomy.
I’ve developed a list of FAQs below that will hopefully answer your most pressing questions.
Though I cannot anticipate every possible outcome, I have identified what you may expect when working with an out-of-network provider:
1. You cover the cost of therapy yourself, submit a receipt (Superbill) to your insurance carrier, ask for reimbursement, and get a portion of the fee covered.
2. Your employer provides you or you have an HSA or flexible spending account which you can use to cover the cost of therapy services.
3. You cover the cost of therapy yourself, submit a receipt (Superbill) to your insurance carrier, ask for reimbursement, and due to your specific plan your insurance carrier may reimburse you for a percentage of the amount you paid me.
FAQ
1. What exactly does it mean that you’ve “ended your contract” with my insurance?
This means I am no longer an in-network provider and am now considered an out-of-network provider (OON).
2. Can I use my out-of-network benefits?
Yes! My choice to no longer contract with insurance does not mean you cannot utilize your out-of-network benefits. I would encourage you to call your insurance company and ask them the following questions:
Do I have out-of-network coverage for behavioral health?
What is my out-of-network deductible? (This part is really important to clarify since many plans have a DIFFERENT out-of-network deductible)
Once my deductible has been met, at what percentage does my plan cover out of network behavioral health services? Is there an “allowed amount” for CPT code 98037 or do you use the $155, the amount paid to the provider?
3. Is there a way you, my therapist, can help me get reimbursed by my insurance carrier?
Yes. I am able to generate a special “receipt” called a Superbill, which you can then submit to your insurance company for reimbursement. Please note that included on this form there will be a diagnosis. I will email you the superbill either the day of your session or monthly. I do not submit your Superbill to your insurance. The reimbursement check is only allowed to be sent to the person who sent in the Superbill.
4. Now that insurance isn’t paying you directly, how will we handle payments?
All payments are due at the end of your session with me. If you want to pay by check or Zelle there is no processing fees. If you want to use credit card, with the processing fees of 3.5%, then I will keep that credit card on file with Square and my automated system will charge your card the day of our session. Venmo includes a processing fee of 2.5%, and you will be asked to complete your payment immediately at the end of a session.
5. Once I submit a claim to my insurance company, when and how will I get a reimbursement?
The answer to this question will vary depending on your carrier’s policies. Typically the insurance company will mail you a physical check. As a general policy on my end, I do not accept payment from insurance companies when I am out-of-network. How long it to receive the check varies, most commonly is around 30 days to process claims.
6. I can’t afford to keep seeing you if I’m now responsible for paying your full fee up front. What are my options?
If you do not have out-of-network coverage, or paying my full fee is not an option for you, and prompts you to consider terminating therapy prematurely please talk to me directly. The plan we come up with will be individual to your needs, but here are some likely options:
You and I agree to a reduced fee for a limited period of time.
You and I spend the next few months thoughtfully transitioning you to another therapist who is in-network with your insurance company. You may choose to transition earlier then then April. I am curating a list of in network therapist accepting new clients to offer you.
Again, I understand that paying for therapy services directly emphasizes the commitment and investment you have to yourself. I invite this change in my practice as an opportunity for you and me to clarify and reinforce therapy goals to ensure your time with me matches the values we are striving for.
Please let me know if you have further questions or want help problem solving what this change will mean for you. I’m glad to e-mail on this topic, talk during our next session, or set up a time for a phone call.
With care and grace,
Karen Lucas LMHC, LMP
