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.
Work in progress – not complete, but will be frequently expanded on. If there are any specific questions you would like answered here, contact us!
Below are some of the questions we frequently answer:
What insurances are you considered “out of network” for?
All other insurance companies that are not the ones listed above for each therapist.
We 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. 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.
Why is marriage/family/couples counseling not billed through my insurance?
Marriage/couples/relationship counseling is not billed through insurance because insurance does not approve those services as “medically necessary”. Relationship counseling focuses on improving relationships and communication between spouses, partners, relatives, families, etc..
“Medically necessary” refers to healthcare services or treatments that are required to diagnose or treat medical conditions. In other words, these are services that are deemed essential for the patient’s health and well-being, based on medical evidence and professional judgment. Medically necessary services are typically covered by health insurance plans, whereas services that are not medically necessary will not be covered.
Our previous therapist was able to use our insurance for relationship counseling. Why won’t you?
It is very unfortunate that this happens! We know that there are therapists that bill insurance with different “work arounds”. For instance, billing one person’s insurance and using a code that says two people are in the session. Ethically, that is saying that the identified person is the client and the other person in the session is participating sometimes. In the end it’s insurance fraud and, if caught, has big consequences.
Unfortunately therapists using these tactics are part of the problem. We advise everyone to complain and bring up this issue with insurance companies. Advocacy and social pressure have made changes in the past when it comes to insurance companies.
I called my insurance company and they confirmed that they cover marriage counseling.
This is another issue we encounter constantly. We do not doubt that representatives said that the insurance plan/company reimburses for marriage/family counseling. They are assuming it is like the scenario above where 1 person is in treatment and the significant other comes into the session. That is presuming that it is still under “medical necessity” justification. That is not what is happening in couples counseling.
A better question to ask your insurance company is:
Does my plan cover marriage counseling with the primary diagnosis code Z65.9 or any Z-code? How about a V-code?
Z and V codes are diagnosis codes that note stressful situations that might have a negative impact on mental health. For instance, Z65.9 is an Unspecified Problem Related to Unspecified Psychosocial Circumstances. There are many different types, but still: not considered “medically necessary” by insurance company standards.
Does that mean I can’t get reimbursed at all for marriage – relationship – couples counseling?
We have recently learned that some insurance companies may reimburse you with the submission of a receipt. We will provide you a receipt after sessions for you to use for reimbursement purposes. Contact your insurance company for information as to what they need.
How much are services?
We realize the pricing structures were confusing! Here are the simplified and most current prices as of January 26, 2024:
- Individual Intake (60 – 80 min) – $200
- Individual Session (50 min) – $175
- Individual Session (30 min) – $125
- Relational Counseling (marriage/couples/family) Intake* – $250
- Relational Counseling Session* (50 min) – $250
- Relational Counseling* (30 min) – $150
- Couples Compass* – $600
Substance Use Related Services
- Forensic Substance Abuse Evaluation* – $500
- [Expedited] Forensic Substance Abuse Evaluation* – $700
- SAP Department of Transportation Evaluation* – $500
- Psychological Evaluation (not court mandated)* – $500
- Letters and report writing – $100
*Insurance does not cover