Insurance is confusing & confounding. I aim to make my rates and the insurance process as upfront and transparent as possible.
Below is a general outline of what to expect. There are always exceptions to how things can and do go, particularly when we involve insurance. I am always open with my clients about the insurance process and encourage folks to bring up questions or concerns as often as needed throughout treatment.
Cancelation Fee: If you cancel less than 24hrs before your appointment time or no-show, you will be automatically charged the cancellation fee of $150. This policy is strictly enforced. Occasional exceptions may be able made for unavoidable emergencies or extenuating circumstance (ex. health or family crisis, emergency room visit, car accident, profound unexpected transit delay, not including normal variations in traffic congestion, or normal train/bus delays).
Examples of what is NOT generally considered an extenuating circumstance: forgetting your appointment, forgetting you had another appointment/obligation during your regularly scheduled therapy time (ex routine medical appointment, hair/nail appointment, work meeting, or class), normal variations in traffic or transit delays (please plan for traffic/weather/normal train/bus delays and leave earlier or ask to change to telehealth when congestion or delays may be more signficant such as during big city wide events or inclement weather).
-You may cancel for any reason with greater than 24hrs notice, no questions asked. However, since attendance is important to reach your goals, frequent cancelations may result in discussion with your clinician about wether or not the current available session times work with your schedule.
Self-pay rates: $275 for initial session. $220 for follow-up sessions.
In-Network Insurance: most Blue Cross Blue Shield & Aetna PPO plans.
Out-of-network (OON): if you'd like to use your out-of-network benefits, you will pay the full self-pay fee upfront and be provided with a "Superbill" to submit to your insurance company for reimbursement. OON claims fall solely to the client to understand, submit, and manage. Please check with your insurance company prior to scheduling an initial appointment to verify your OON benefits. Make sure that you fully understand how to file claims, what your OON deductible, coinsurance, and OOP max are ect. MCD has no role in OON reimbursement beyond proving clients a Superbill. Your insurance company may reimburse you for all, part, or none of the rate you paid your clinician. This is solely between you and your insurer, neither MCD or Dr. Michaels have any control over when or what you will or will not be reimbursed.
I am NOT in-network with: any HMOs, or Medicare or Medicaid plans (CHP/Community Health Plans) from any state.
- All clients are required to have an active credit card with sufficient funds on file at all times unless some other arrangement has been explicitly worked out. All fees are due at time of service or missed session (canceled less than 24 notice). If your card is declined, you clinician will inform you as soon as possible, and you will have 1 week to update your card with your clinician. After 1 week, you may be asked to pause any future sessions until you update your payment.
- Many clients can use their FSA or HSA funds for therapy sessions, and I encourage you to look into this if you have one or both of these accounts available to you.
- Client Account Balances: Failure to keep up with your account balance may result in a pause or termination of treatment with referrals for sliding scale services.
Cancelation Fee: If you cancel less than 24hrs before your appointment time or no-show, you will be automatically charged the cancellation fee of $150. This policy is strictly enforced. Occasional exceptions may be able made for unavoidable emergencies or extenuating circumstance (ex. health or family crisis, emergency room visit, car accident, profound unexpected transit delay, not including normal variations in traffic congestion, or normal train/bus delays).
Examples of what is NOT generally considered an extenuating circumstance: forgetting your appointment, forgetting you had another appointment/obligation during your regularly scheduled therapy time (ex routine medical appointment, hair/nail appointment, work meeting, or class), normal variations in traffic or transit delays (please plan for traffic/weather/normal train/bus delays and leave earlier or ask to change to telehealth when congestion or delays may be more signficant such as during big city wide events or inclement weather).
-You may cancel for any reason with greater than 24hrs notice, no questions asked. However, since attendance is important to reach your goals, frequent cancelations may result in discussion with your clinician about wether or not the current available session times work with your schedule.
Self-pay rates: $275 for initial session. $220 for follow-up sessions.
In-Network Insurance: most Blue Cross Blue Shield & Aetna PPO plans.
- Midwest Counseling and Diagnostics (MCD) will do a "Verification of Benefits" (VOB), and you will be provided with a "Quote of Benefits" (QoB) before your first appointment. This quote of benefits is what the insurance representative tell's MCD's Billing department and will include the expected co-pay/co-insurance, deductible, and out of pocket (OOP) max for your plan so you can have an idea of what your out-of-pocket costs may be. The QoB is simply a quote of what your policy may cover and is NOT a guarantee of coverage. If your insurer determines they will not cover the service (which only occurs after the session, typically with a several week delay) you will be responsible for all fees.
- Insurance is billed on your behalf by the Billing Department at MCD.
- Copays/deductibles/fees due at time of service.
- In the event insurance denies your claim, it is you, the client, who will be responsible for the full cost of any sessions you have had. It is the client, not the insurance company who is the guarantor on the account and ultimatly responsible for any fees. Please be prepared for that possibility, while it is rare, it can happen. Insurance companies often take 4-8weeks+ to process claims, so therefore you may have had 4-8 sessions before we find out that your insurer has decided to not cover the claim, which means you will likely be responsible for 4-8 sessions worth of fees. In the unlikely event this happens, MCD is happy to work with you on a payment plan for your balance.
Out-of-network (OON): if you'd like to use your out-of-network benefits, you will pay the full self-pay fee upfront and be provided with a "Superbill" to submit to your insurance company for reimbursement. OON claims fall solely to the client to understand, submit, and manage. Please check with your insurance company prior to scheduling an initial appointment to verify your OON benefits. Make sure that you fully understand how to file claims, what your OON deductible, coinsurance, and OOP max are ect. MCD has no role in OON reimbursement beyond proving clients a Superbill. Your insurance company may reimburse you for all, part, or none of the rate you paid your clinician. This is solely between you and your insurer, neither MCD or Dr. Michaels have any control over when or what you will or will not be reimbursed.
I am NOT in-network with: any HMOs, or Medicare or Medicaid plans (CHP/Community Health Plans) from any state.