Fees and Insurance

Fees and Insurance

Is psychotherapy covered by health insurance?

Yes, thanks to a massive legislative effort on behalf of mental health and well-being.

Is it complicated to get insurance to pay for psychotherapy?

It's actually pretty simple, but it helps to be an informed consumer!

Like most experienced psychologists and psychotherapists in DC, I don't take insurance directly. Patients pay me, and then file for reimbursement from their health insurance. Nearly all of my patients file for reimbursement, and the vast majority are reimbursed 50-80% of my fees. If you decide to submit a claim for insurance reimbursement, I'll gladly help.

If this is your first time filing an insurance claim after paying a healthcare provider directly, rest assured that my patients routinely find that the process is much simpler than they thought it would be -- plus, you'll have me in your corner, and I'm a fierce advocate.

I've helped patients get fair and accurate reimbursement for psychotherapy from a wide variety of insurance carriers, including CareFirst Blue Choice, Blue Cross / Blue Shield, United Healthcare, Aetna, Cigna, and more.

I've even written a guide to help you get the right reimbursement from your insurance company -- you can find it here: Insurance Reimbursement for Therapy.

What's your fee for psychotherapy?

For individual therapy, my current fee is $275, close to the typical fee for therapy in the Washington, DC area.

Fair Health Consumer, a consumer rights website, shows that the Typical Provider Charge in 2022 for individual psychotherapy in Washington DC is $230. Here's how to look up the Typical Provider Charge for psychotherapy, or for any healthcare cost.

Please feel free to contact me with any questions or concerns you have about fees and insurance.

Marsha Lucas, PhD - Psychologist
1350 Connecticut Ave NW, at Dupont Circle
Washington, DC 20036
(202) 331-3318

_____________________

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE
MEDICAL BILLS
(OMB Control Number: 0938-1401)

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

• Your health plan generally must:

    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the Secretary of State for the District of Columbia: Phone (202) 727-6306. Email: secretary@dc.gov.

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.