Fees & Insurance

Understanding Your Insurance Benefits

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Insurance coverage for mental health can be confusing, so we want to make sure you understand your coverage as well as possible prior to starting therapy at Creative Coping. 

Although we do verify insurance benefits for all new clients before treatment begins, ultimately, it is your responsibility to learn what your own benefits are. It is also your responsibility to inform us if your insurance plan has changed or ended. If Creative Coping is not in-network with your new plan, or your insurer denies your claim because your coverage has ended, you (not your insurance company) will be responsible for the full payment of services rendered.

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We strongly recommend that you reach out to your health insurance company to inquire directly about your mental health benefits. Here is how you can obtain information about your benefits and coverage before your first session:

 

1. Online: You can log in to the members portal of your insurance plan. Your personal benefits information can be viewed in your online account. 

2. Phone: Often the easiest way to check your benefits is to call the phone number on the back of your insurance card to inquire about your coverage. When you get a representative on the line, tell them you are inquiring about your mental health (sometimes called behavioral health) benefits and coverage for an outpatient, office setting. We also recommend that you get the name and reference number of the call to refer back to in case something goes unexpectedly with your coverage.

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You may need to provide your name, subscribe/member number, and your DOB.  You may also need to provide Creative Coping’s National Provider Identification Number (NPI) which is:

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Type I (individual) #: 1376705251 (name: Alison Schroeder)

Type 2 (group) #: 1982482287 (name: Creative Coping)

 

Here is a brief explanation of some of the insurance lingo you may encounter: 

 

Co-pays or coinsurance: Your coverage may pay for all or part of your session fees, depending on your plan. A copay is the same amount for each session, which you are required to pay on the dates of your session, and your plan will cover the rest. Co-insurance is similar to a copay, usually around the same amount, but it is calculated as a percentage of the session fee. We usually see co-insurance with plans that have deductibles. Typically, after you hit your deductible, your insurance plan will begin paying a certain percentage directly to the provider, and you’ll be responsible for the difference (for example, you pay 20%, they pay 80%). The amount you owe is not due at the time of service, because the insurance claim needs to be processed first before we know for sure what your “patient responsibility" will be. 

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Deductibles: If you have a deductible to meet, and if the deductible applies to outpatient mental health services, then the representative (or the website) will inform you of the amount of your deductible and the amount you have already paid towards the deductible so far this year. Make sure to ask if the deductible starts over on January 1 of each year (most common) or if not, what date it starts over. The representative should also be able to tell you the maximum amount you are responsible for paying for one therapy session (which is set by the insurance company, not us). This is called the contracted rate or the agreed-upon rate, and it changes frequently and varies from plan to plan.

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CPT codes: There are different codes for different services that the insurance company will reimburse. The most used codes for individual, outpatient mental health counseling in an office setting are:

90791-Intake (45-60 min)
90837-Individual therapy (53+min)

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FOR PRIVATE PAY OR OUT OF NETWORK CLIENTS

 

If you are private pay or out of network, we can provide you with a billing statement, called a "superbill", each month for you to submit for reimbursement from your insurance provider. We try to keep our self-pay rates as close to our insurance contracted rates as possible. The exact amount can change slightly over time, as insurance companies update their fee schedules. If you are a self-pay our OON client, we will make sure you know your exact fee before treatment begins.