Demystifying Your Insurance Coverage for Therapy in DC

If you’re searching for a therapist in DC, you’re likely already feeling stressed, anxious, sad, deflated, or angry — or some combination of all of those.

Unless you’ve done therapy in DC before, it can be a confusing surprise to discover that using your insurance for therapy isn’t at all like going to see a physician or other health care provider.

Becuase it’s different and complicated, we know that a lot of people decide therapy isn’t worth the hassle.

You’re not alone if you feel that way, and it’s why we work to simplify the process by leveraging technology so you can instead focus on feeling and doing better, rather than understanding insurnace claims.

 

First, A Big Distinction When it Comes to Insurance and Therapists in DC

When it comes to therapists in DC and insurance there are two main types of practitioners:

  • In-Network – Those who directly take insurance
  • Out-of-Network – Those who do not directly take insurance

In-Network Therapists

Unlike physicians in DC, it’s difficult to find therapists who directly accept insurance. There are historical and administrative reasons why that is the case. Bottom line, they are somewhat rare.

Out-of-Network Therapists

In our experience, most therapists in DC are Out-of-Network. But don’t give up yet. It’s still possible to use your insurance to help you pay for therapy — it just happens via an indirect route. That way involves using your out-of-network insurance benefits (see below for how to check if your policy has those) and then submitting for reimbursement.

Just to be clear, similar to most therapists in DC all of us in our practice are out-of-network too.

 

How To Find Out What Your Out-of-Network Mental Healthcare Benefits Are

If you’d like to confirm with your insurance company what your out-of-network benefits are, call them and give them this CPT code: 90834.  That’s one of the most common codes that insurance companies use for a therapy session.

Ask them these important questions:

  • Do I have out-of-network coverage?
  • What is my annual deductible?
  • What percentage of their fee can I expect back if I see a licensed psychologist?

The answers to those questions will help you calculate a good estimate of what you can expect to receive back from your insurance company.

A quick estimate: Most of our clients get back 50-80% of our fees after they’ve met their yearly deductible when using their out-of-network benefits with us.

 

The Process of Using Your Out-of-Network Benefits

In our practice it looks like this since we leverage technology to make the process easier for our patients:

  • You pay us our fee via credit card, health savings account (HSA), check, or cash at the end of each session.
  • Using your insurance information that we keep on file, we prepare and send a request directly to your insurance. 99% of the time you don’t have to do a thing.
  • In approximately 2-4 weeks you can expect to be notified by your insurance company that they received that request and any reimbursement that is due to you at that time.

 

Levering Technology: We Takes Care of the Confusing Paperwork

To make the process much easier for you, we use technology to submit your requests for out-of-network reimbursement to most the common insurance companies in the DC area.

In a nutshell, that means that we electronically file all the necessary paperwork with your insurance company so that you don’t have to hassle with out-of-network forms, which can be a significant pain.

For a frame of reference, with most other therapists in DC have you instead file the paperwork yourself. Once you’ve done it a few times, it’s a relatively straightforward, though perhaps annoying process. However, our belief is that we should do what we’re able to make the payment process as easy as possible.

 

We’ll Use Our Experience To Help Guide You

We’ve been helping our patients navigate the out-of-network insurance process for almost two decades and we’ve learned how to make it much more straightforward. If you’re currently facing big challenges in life, contact us and we’ll be happy to see how we can be of help.