Fees & Insurance
At Calm Seas Group, we treat all individuals with respect, sensitivity, and compassion. We recognize that everyone is unique and deserves care tailored to their needs. We understand that stigmatizing labels can be harmful and oppressive, so we take great care to avoid such language in our practice.
We appreciate that everyone has a unique story and set of experiences, and we are committed to honoring each person's journey with sensitivity and compassion. We do not believe in haphazardly throwing around diagnoses that can further marginalize and oppress individuals. Instead, we work collaboratively with our clients to understand their unique challenges and develop personalized treatment plans that meet their needs.
Insurance
Using your health insurance benefits to pay for therapy can be convenient and cost-effective for many people. However, before opting to use these benefits, there are also some potential drawbacks to consider. Here are some pros and cons of using insurance to pay for therapy:
Pros:
Reduced cost: One of the main benefits of using insurance to pay for therapy is that it can significantly reduce the out-of-pocket cost for clients. Depending on the insurance plan, clients may only be responsible for a copay or a portion of the total cost of the session.
Greater access to care: For people who cannot afford therapy without insurance, insurance can be the only way to access the care they need. Insurance plans often have a network of providers, making finding a therapist who accepts their insurance easier.
Increased accountability: Insurance companies often require therapists to document progress notes and treatment plans, which can help ensure that therapy is effective and that clients progress toward their goals.
Cons:
Limited options: Using insurance to pay for therapy may limit the number of therapists and treatment options available. Insurance companies often have a limited network of providers, making it difficult to find a therapist who is the right fit.
A limited number of sessions: Insurance plans get to do what they want. As such, insurance companies often limit the number of sessions or types of therapy they will cover. They may decide to cover your therapy sessions no longer if they believe that therapy is no longer of medical necessity for you. This can make it difficult for clients to receive the care they need.
Privacy concerns: When using insurance to pay for therapy, clients must disclose personal information to their insurance company, which can compromise their privacy and confidentiality.
Diagnosis: Insurance companies require a mental health diagnosis to cover therapy sessions, which can be stigmatizing and potentially impact future insurance coverage, including life insurance.
Ultimately, whether or not to use insurance to pay for therapy is a personal decision that depends on individual circumstances and preferences. It's crucial to weigh the pros and cons and choose the option that works best for you.
For those seeking services who may already have a "diagnosis" or are willing, or wanting, to be diagnosed to use your health insurance, we accept the following insurance plans:
Cigna
Aetna
Oxford
United Healthcare
Oscar Healthcare
Private Pay
Paying out of pocket for mental health therapy, or private pay, can offer some benefits and drawbacks. Here are some pros and cons to consider:
Pros:
Increased flexibility: Private pay therapy can offer greater flexibility in scheduling, session length, and treatment options. Without the constraints of insurance requirements, therapists may have more freedom to tailor their approach to the client's needs.
Increased privacy: Private pay therapy can offer greater privacy and confidentiality. Insurance companies often require disclosing diagnoses and other personal information, which can compromise confidentiality.
Greater choice of therapists: With private pay, clients can choose any licensed therapist they wish rather than being limited to those who accept their insurance. This can increase the likelihood of finding a therapist who is a good fit.
No diagnosis required: Unlike insurance, private pay does not require a mental health diagnosis in order to receive treatment. This can be beneficial for clients who may be concerned about stigmatization or future insurance coverage.
Cons:
Cost: Paying out of pocket for therapy can be expensive, especially if therapy is needed over a long period of time. Without insurance coverage, clients are responsible for the total cost of therapy.
Limited financial resources: Some individuals may not be able to afford private pay therapy, which can limit access to care.
No insurance reimbursement: Clients who pay out of pocket for therapy are not eligible for reimbursement from their insurance company.
No accountability: Without the oversight of an insurance company, there may be less accountability for the therapist and less assurance that therapy is effective.
Whether private pay therapy is the best option depends on individual circumstances and preferences. It's important to weigh the pros and cons and make the most informed decision.
Private Pay Rates
Individual:
60-minute intake session (includes post-session treatment plan creation): $250
45-minute individual, ongoing session: $150
60-minute individual, ongoing session: $200
75-minute individual, ongoing session: $250
Paperwork, per hour, minimum 1-hour: $100
Collateral phone calls, emails, per hour, minimum 1-hour: $100
The missed appointment fee (less than 24 hours) equals your session fee.
Couples:
75-minute intake session (includes post-session treatment plan creation): $300
75-minute couples, ongoing session: $250
90-minute couples, ongoing session: $300
Paperwork, per hour, minimum 1-hour: $100
Collateral phone calls, emails, per hour, minimum 1-hour: $100
The missed appointment fee (less than 24 hours) equals your session fee.
Superbill
If you're looking to get reimbursed for out-of-pocket therapy sessions, you can do so by submitting a Superbill to your health insurance provider, such as BCBS HMO. At Ace Counseling Group, out-of-network services may be covered by your health insurance or employee benefit plan when you provide them with a Superbill. You can check our rates and in-network insurance providers on our website.
A Superbill is a document that outlines the services you received from an out-of-network counselor, including the date of service, service codes, diagnosis codes, and the billed amount. Patients can use a Superbill to request reimbursement from their health insurance. The amount reimbursed depends on the individual's healthcare policy.
What should be included on a Superbill:
Provider Information: Therapist's name, NPI number, office location, contact details, and referring provider's information (if applicable).
Patient Information: Patient's name, address, phone number, and date of birth.
Service Details: Date of service, procedure code (CPT), diagnosis code (DX), modifiers (if any), units/minutes, and fees.
To request and submit a Superbill, most providers require you to ask for one. After obtaining it, contact your insurance company to understand your out-of-network benefits, the process for submitting a Superbill, and ensure your address is up-to-date on file.
Key questions to ask your insurance company:
What are my out-of-network healthcare benefits for behavioral health?
Is pre-authorization required?
What is the co-payment, deductible, co-insurance, and timely filing limit?
If pre-authorization is needed, initiate the process with your therapist's information.
After submitting a Superbill, it typically takes about 2 weeks for the insurance company to process it. If approved, they will send reimbursement. If not, contact them to inquire about the status and reasons for denial.
In case of denial, you can contact your employer's Human Resources Benefits Specialist to assist in resolving the issue.