Therapy, the process, insurances, and all the “lingo” involved can be overwhelming! We believe the more we help give you information, the more empowered you become to take charge of your mental health. Below is our primer with the most frequently asked questions we get.
Frequently Asked Questions
Insurance Related
What insurance do you take as “in network providers?”
- Dr. Nelson accepts: Carefirst BC/BS
- Joseph accepts: Carefirst BC/BS and Anthem
- Kate accepts: Carefirst BC/BS and Anthem
- Cleo accepts Anthem (Not FEP)
What insurances are you considered “out of network” for?
All other insurance companies that are not the ones listed above for each therapist.
Dr. Nelson, Joseph, and Kate are approved out of network providers for Tricare, which acts differently than other insurances.
What does “insert insurance term here” mean?
Here is a quick overview of different terms you may hear:
In Network (INN) – This means that the therapist has signed a contract with an insurance company and has become part of their network of providers. They have made an agreement to take the fees from the insurance company instead of the client. Depending on the insurance company and plan, the client pays only a copay.
Out-of-Network (OON) – The therapist has not agreed to be included in an insurance network. Their services may or may not be reimbursed (or accepted) by the insurance company. **Important** Out of network benefits differ between plans and insurance companies. Call your insurance company and as what your OON benefits are, if any. Do NOT assume you can see an out of network provider and get reimbursed.
Copay – the amount that a client pays for a service. It’s part of the agreement between the client and their insurance company. Think of it as your “share” of the costs after the insurance company has paid their “share” of the bill.
Deductible – The amount of money you have to pay before your insurance company starts “sharing” the cost with you. For instance, if your deductible is $1,000, you pay $1,000 out of pocket before your insurance company will start making payments.
Medically Necessary – This is used to describe services that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms. These must meet accepted standards of medicine.
What does Tricare “out-of-network approved provider” mean?
This can get confusing really quick, but here’s the easiest way of explaining it.
Therapists must be vetted by Tricare to approve their services if they are not “in network” with them. They are called “non-Network providers“. This allows clients to access mental health services outside of their approved network, but still use their insurance. This is actually a great thing since Tricare ensures that therapists, even though they do not want to participate with the Tricare network, still uphold the education and licensure requirements needed to provide good care.
If a client sees a “Tricare approved provider” and pays out of pocket (full therapist fee), the session claim may be submitted to Tricare and processed for direct reimbursement to the client.
If a client sees a therapist that is not in-network or “an approved provider” and pays out of pocket, there is a high chance the session will not be processed by Tricare.
If a client chooses a therapist that is in-network with Tricare, they pay only their co-pay. That is the benefit of staying within network! The problem is finding available therapists or getting an initial appointment sooner rather than later.
Our therapists are Tricare approved for out-of-network services. When you meet with a therapist at Virginia Counseling Services, you pay the full amount after each session. We then submit to Tricare a claim on your behalf (which means you don’t have to do anything). The claim gets processed by Tricare and any reimbursement amount (depending on your plan) gets mailed to you directly.
We highly recommend that you call Tricare and ask them the particulars of your plan!
How can I find out what my out-of-network benefits are?
The best way is to contact your insurance company and ask them to detail the particulars of your plan. To help guide you on this conversation with them, we have an easy document to help ask the most important questions: OON Insurance Questions
Important Information About Using Insurance
Insurance and Confidentiality
There are multiple problems with confidentiality that comes along with the acceptance of insurance that is a disservice to clients needing assistance. Insurance companies require a diagnosis in order to consider how many sessions you may have or if they will cover therapy. Along with a diagnosis, they oftentimes want confidential information about client problems, history, current situations and the course of treatment. There are potentially countless amount of insurance company employees that review this information. There are also 3rd party companies that are sometimes contracted by insurance companies for reviewing and approval of claims.
Mental health and substance abuse problems are private, personal, and too important to be given out to managed care companies.
Involving insurance companies means that Client-Therapist confidentiality is compromised and insurance companies may request records of treatment for their consideration. These records become part of your medical records and are outside of the control of the client or therapist. What that means is that the client nor the therapist have any control over who sees the information, where it goes afterwards, and what is done with it.
Confidentiality of our clients is our top priority! Many people do not realize the access that insurance companies have on their mental health records from contracted therapists in their network and the loss of control over the information after it has been released.
If you still wish to use your insurance benefits and understand the implications of doing so, we will assist you by submitting on your behalf for reimbursement from your insurance company. For questions about possible health insurance submissions, please call (202) 630-1765 and we will gladly help you understand the process.
Services Related
Why is marriage/family/couples counseling not billed through my insurance?
Insurance covers medical necessity, a diagnosis, symptoms, a treatment plan tied to a clinical condition. Relational work is not that. It is communication, connection, and the everyday friction of being in a relationship, and none of that requires a diagnosis to be worth working on.
Our previous therapist was able to use our insurance for relationship counseling. Why won’t you?
Some practices bill it anyway, often by attaching one partner’s individual diagnosis to a couples session. We do not do that. If an insurance company reviews the claim later and decides the session was not medically necessary, they can take the payment back from the provider, and that cost has a way of landing on the client eventually. We would rather be upfront about the cost now than risk a surprise bill later.
I called my insurance company and they confirmed that they cover marriage counseling.
Some plans do cover it under specific circumstances, usually tied to an individual diagnosis rather than the relationship itself. We are glad to hear you checked. We still bill this as private pay, for the reasons above.
Does that mean I can’t get reimbursed at all for marriage – relationship – couples counseling?
For relational work specifically, no, we do not have an out-of-network submission process set up the way we do for individual therapy. This is private pay only, no superbill, no OON claim path. If cost is a concern, that is worth talking through directly, there may be other options depending on your situation.
How much are services?
Current prices as of March 1, 2026:
Notice to our Current Clients of Price Increases – March 2026
Individuals
- Individual Intake (60 – 80 min) – $225
- Individual Session (50 min) – $185
- Individual Session (30 min) – $165
Relationships (Marriage/Couples/Family)
- Relational Counseling Session* (50 min) – $285
- Relational Counseling* (30 min) – $165
- Relational Counseling* (80 min) – $450
- Couples Compass* – $800
Substance Use Related Services
- Substance Abuse Evaluation* – $650
- [Expedited] Substance Abuse Evaluation* – $750
- SAP Department of Transportation Evaluation* – $650
Miscellaneous
- Psychological Evaluation (legal use) – *1,250
- Comprehensive Forensic Evaluation* – $3,000+
- Letters and report writing – $150
- Cancellations less than 48 hours in advance or no-shows* – Full fee of appointment at cash rate
*Insurance does not cover