need help talking to your insurance company?
It’s not as bad as you think!
insurance reimbursement 101
Psychotherapy has long been established as an effective method of health care, and is routinely covered by insurance, depending on the details and requirements of your policy. It helps to be an informed consumer when asking your insurance company for reimbursement.
Like many psychologists and psychotherapists in the Denver area, I don’t contract with insurance companies. Patients pay me directly, and then file for reimbursement. If you decide to submit a claim, I’ll be glad to help you.
My Fees for Psychotherapy:
The cost of psychotherapy with me is $200 for a 60 minute appointment, consistent with the typical cost of psychotherapy in the Denver metro area. My practice area is in zip code 80210, and as of 2022, customary fees in this zip code are $206; this amount includes expected charges for both doctoral and master’s level practitioners.
Understanding How Insurance Companies Determine Reimbursement:
Insurance companies may use creative ways to calculate your coverage amount! For example, if your policy states that it will cover, say, 70% of the cost of therapy, that may mean it will cover 70% of what they say therapy costs. This may vary from the actual cost that is typical in your area. That may be based on what’s referred to as “usual, customary, and reasonable” (UCR), or “reasonable market value”, but there are few regulations for how they determine that number. Or they may use Medicare, an insurance specially negotiated for people over the age of 65, as a cost basis, even if you’re not on Medicare.
Fortunately, there’s a consumer rights website, Fair Health Consumer, where you can see what an objective source says therapy actually costs. To determine the UCR (Fair Health Consumer uses the term “Typical Provider Charge”), do the following:
Enter the zip code for my practice: 80210
Enter the procedure code (CPT code): 90837 (Psychotherapy, 60 minutes)
Click “See Out-of-Network Reimbursement”
This will be the real, customary cost for psychotherapy in your area. Use this number when you call your insurer.
How to Call Your Insurance Company:
When you call, they’ll let you know what your insurance covers in general terms, such as 70% of the UCR. For example, if your insurance company considers $200 to be the UCR, then your reimbursement would equal $140, or 70% of $200.
If you were to call about reimbursement for therapy with me, you’d give your insurer this information:
You’ll be submitting claims for “Individual Psychotherapy, Outpatient, 60 Minutes”, which is referred to as CPT code 90837.
My current fee for CPT code 90837 is $200.
My zip code is 80210.
I’m a licensed psychologist, and I’m a non-participating provider, which means that I don’t have a contract with your insurance company.
Then ask them if your therapist’s fee is within the range of what they use to determine reimbursement. If they comment either way, it will likely be either “yes” or “no”.
If they say “no”, or that they can’t say, you can tell them that you’ve used the Fair Health Consumer website to look up the Typical Provider Charge for psychotherapy in your area, and the amount is $___. Then ask them if that’s the number they use to determine reimbursement, and if not, why not!
If you choose to work with me in therapy, I will provide you with a “superbill” of my services which you may then submit to insurance. If you need more help, let me know!