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insurance and fees

FAQ


Insurance and Fees - FAQ

Therapy is an investment in you. When evaluating costs for treatment, please keep in mind your values for your own health and well-being. We realize everyone has different financial means and we do our best to meet you where you are at and work with your individual financial circumstances.

We also do our best to be as informed as possible when working with insurance. Please understand that in some circumstances, your plan may have a deductible that must be met before coverage / benefits are available to you. While a deductible of $300-$1000 may be expensive, it indicates that you have relatively good coverage compared to other plans which have deductibles in excess of $5000-$10000 before benefits become active.

Please refer to the linked guide below for details on how to verify your benefits coverage. You will be told that any information provided is not a guarantee of payment, but it is often accurate regarding your individual plan.

Diagnosis

We are required to demonstrate medical necessity when insurance (both in and out-of-network), HSA accounts, and EAP coverage is used. This means we will assign a formal diagnosis in all of the above circumstances. With private pay, we will diagnosis when indicated. We will discuss all diagnoses with you.
Insurance Benefits Verification

Cancellation and Rescheduling Policy

We require 24 hours notice for cancellations and rescheduling requests. If you cancel with less than 24 hours notice, or no show to your appointment, we charge a $100 late cancellation / no show fee. Please contact you provider directly, or our main office at 828-845-8192 or at [email protected] if you need to cancel or reschedule.

Considerations for Insurance

There is not a right or wrong answer to whether using your insurance benefits is right for you. For many people, using their insurance benefits significantly reduces the cost of care with us and other medical providers.

There are several important caveats with using insurance:
1.) All insurance billing, whether in- or out-of-network, requires a diagnosis and medical necessity. Most diagnoses are covered, but some such as V or Z codes (e.g. Relationship Distress With Spouse or Intimate Partner or Uncomplicated Bereavement) may not be covered. Some people may not wish to have a diagnosis applied to them, which may preclude you from using your insurance benefits for counseling services.
2.) Insurance companies reserve the right to request a summary of treatment or your full medical record to establish medical necessity when your benefits are used.
3.) Some insurance plans may require preauthorization or limit the number of sessions they may pay for.
4.) Insurance companies set the reimbursement rate for services. If you have a deductible and wish to use your in-network benefits, the cost of your session is determined by the insurance company rather than established by you and your provider.
5.) There is not a properly established procedure code for couples counseling, which means that even though there is a diagnosis code that may be covered, there is not a corresponding procedure code for couples counseling (versus individual counseling with another present or family counseling).
6.) Insurance companies will not commit to out-of-pocket costs for in-network services prior to processing a claim. As such, we do our best to provide you with an estimate of what we think your portion of payment will be ahead of working with you, but we will not be able to know for sure what they will pay until the first claim submitted is processed and marked as paid. Payment information for a service will be stated on an Explanation of Benefits (EOB) available to you and your provider.
There may be additional considerations beyond those listed above which may preclude you from choosing to use your insurance.

In-Network Insurance and Claims

We are paneled and considered in-network with several insurance companies. For many clients with insurance, this is the most affordable option for using their insurance benefits.

With the companies listed below, we will file claims with them directly and they will reimburse us up to their contracted rate, less any of your portion (copay, coinsurance) as a client. Please note that if we file claims and you have a deductible, we are required to collect the contracted rate which is set by the insurance company.

Please see each individual provider’s page for a list of what companies they are paneled with.

Aetna LogoAnthem BCBSBlue Cross Blue ShieldLyra HealthOptumUnited Healthcare

** Please note that you are responsible for your portion of payment for any and all services. **

My insurance isn’t listed above, do you offer out-of-network billing or provide superbills?

Yes, we can assist you with out-of-network billing.

We work with a company named Thrizer that simplifies out-of-network billing. They will collect your payment at the time of service and submit the superbill information to your insurance company.

** Please note that some of our providers may not be eligible for out-of-network billing with a particular plan or company. **

I don’t have insurance, what will my therapy cost?

Our standard rates are $175 for a 75-minute intake and $150 for a 60-minute counseling session. Our providers may have openings at reduced rates and are open to discussing this on a case by case basis.

Good Faith Estimate (GFE)

If you elect to not use your insurance, you will receive a Good Faith Estimate describing how much your care will cost. Due to the nature of therapy being very individual, we are unable to provide a GFE with an exact number of sessions and treatment length at the start of therapy. We will provide you with a GFE identifying session length and rate as agreed upon by you and your provider, reflecting the cost per session. It will include the cost of treatment for 4, 8, and 12 sessions at the agreed upon rate.

Therapy is a unique and fluid process, and it is not possible to anticipate how many sessions will be necessary or appropriate for your course of therapy. Your total cost of services will depend upon the number of psychotherapy sessions you attend, your individual circumstances, and the type and amount of services that are provided to you.

The GFE is not a contract and does not obligate you to obtain any services from the provider(s) listed.

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit https://www.cms.gov/nosurprises/consumers or call 1- 800-985-3059. The initiation of the patient-provider dispute resolution process will not adversely affect the quality of the services furnished to you.

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Mindfulness Counseling Asheville North Carolina

372 Depot St Ste 20 Asheville NC 28801
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