Let’s Do This!
Given our belief in everyone having access to quality mental health care and support, we offer a variety of options to receive services with us.
Storm Haven has both In-Network and Out-of-Network Providers in California for the following insurances: Aetna, Cigna, Optum, United HealthCare, Oxford, Oscar Health, and UMR
Jen is also now live on Headway
While In-Network Providers will file your insurance claim for you, Out-of-Network providers are able to offer a Superbill. This means the client will pay the private pay fee up front for services then be issued a Superbill to seek reimbursement directly with their insurance for Out-of-Network care and coverage.
If you would like to pursue services with an Out-of-Network Provider, your provider is able to discuss specific questions (upon request) that you may ask your insurance company to best determine coverage for services ahead of time.
Private Pay
Are you ready for a pivotal change and getting back to or the rediscovery of your best self?
Beyond the insurances listed above, Storm Haven, Counseling and Wellness is able to offer psychotherapy with providers who are fee-for-service (aka private pay).
Sessions are $180 per 50-minute individual session. Sessions are $225 per 50-minute family and couples session.
While the average session length is 50-minutes, session lengths may vary (dependent on your provider and insurance coverage).
Due to the volume of commitment involved for new clients, intake sessions are $225 may encompass a clinical-driven assessment and mental health treatment planning.
Insurance Fact #1
Your Therapist Must Diagnose You
Within working with insurance companies, there is some valuable information that we have learned along the way. We share this information with you so that you may make informed decisions around your mental health care .
Your Therapist must diagnose to get reimbursed for your care or if you are submitting a Superbill for you to seek reimbursement. Similar to when you go to a medical doctor for a common cold, the medical professional must diagnose you in order to be compensated for the service provided–the same holds true within your mental health treatment.
Beyond diagnostic criteria and meeting medical necessity, some difficulties that clients come to therapy for may not be covered. This is often due to the client’s functioning being well beyond the basic level that managed care (aka insurance companies) will compensate for.
In the mental health field, in general, insurance companies will not reimburse for challenges associated beyond the baseline level of functioning and impairment, which may include growth-oriented areas such as personal growth, values clarification, enhancing a relationship, self-worth, and/or even if the person is just “having a hard time” and being proactive in their care.
This may mean–even for couples or family therapy–at least one individual within the treatment unit must meet medical necessity and receive a diagnosis. This diagnosis may remain a part of your official record permanently. This may not seem like an issue now; however, if later down the road, you seek out new medical coverage, this could mean the difference between obtaining your preferred coverage or none at all.
Insurance Fact #2
Records May not be Protected
When one uses their insurance to receive mental health services, the insurance company may request access to your mental health records at anytime for the purpose of quality assurance and auditing necessity of care.
A record release could potentially impact you if you decide to pursue a high clearance career such as law enforcement or the military.
You may wish to use private pay if you you want to safeguard your records to keep them confidential with few exceptions–such as a judge signed court order or if you, yourself sign a release of records.
Insurance Fact #3
Your Care is Dictated by the Insurance Company and Meeting Medical Necessity
Insurance companies require the therapist to assess, diagnose, create a treatment plan, and keep clinical documentation such as progress notes that detail your treatment.
When individualizing your mental health care and treatment towards the optimal benefit of your needs–your therapist may be required to gain authorization for initial and ongoing therapy, be obligated to share what the focus of your sessions are, how long treatment is anticipated, your acuity, prognosis, functioning level and impact, and other details to support your treatment.
Further, the amount of sessions you may receive may be decided ahead of time per calendar year and/ or limited and may not be based on your true needs.
Once you are functioning at a baseline level then you may no longer meet medical necessary and the insurance company may begin denying compensation for your mental health services.
Overall, insurance is an overall highly intricate and complicated system (think tangled web) and sometimes, despite our best efforts, your therapist may not even be compensated for your care. This could result in an unexpected financial burden as you are ultimately responsible for the cost of your treatment–even if your insurance company does not cover it.
Insurance Fact #4
Insurance Companies Never Pay In-Network Therapist’s the Full Session Fee
Insurances companies, on average, pay less than half (sometimes even less) the providers Usual and Customary Rate.
Clients are often responsible to pay for at least a portion of their session fee via a co-payment.
Clients may need to meet their annual deductibles before insurance will begin compensating for care. With this, upon meeting the deductible, the client may continue to hold some responsibility for paying a co-insurance fee.
For an Out-of-Network provider, you may be ultimately responsible for the difference between what the clinician charges and what insurance pays.
Option #1
Private Pay for Sessions
Paying directly for your sessions may best ensure–with few exceptions–your records remain confidential and all the information between you and your therapist remains between you and your therapist.
This also means your care is decided by what YOU and YOUR THERAPIST think are best –not your insurance company.
You may also request that no diagnosis is documented during treatment—allowing your therapist and you to focus more on holistic care and wellness.
Option #2
If you Need to Use Insurance to Gain Access to Care
You may engage in therapy with an in-network provider and are now informed on the ins and outs of this path : )
If you decide to use an In-Network Provider, your Therapist should be able to discuss what level of transparency the insurance company requires and if you meet medical necessity.
You may also consider using an Out-of-Network Provider and Submit a Superbill for Reimbursement. You would pay upfront and your diagnosis will still be recorded but it will give you the freedom to choose any therapist and your records will be more safeguarded and protected than if you go with an In-Network Therapist. With this, should your insurance company request records, you will have the opportunity to sign a release of records before they can be sent. This puts you in control of whether to send them (or not). Of course, if you decide not to send them, this may result in your session not being reimbursed by your insurance.
