Questions about billing? You’re not alone. Fees and insurance coverage under our current healthcare system can be confusing to navigate. As a starting point, we list our standard fees, discuss some insurance basics and then present two scenarios, in-network and out-of-network. Additionally, the No Surprises Act provides additional protections around health care fees with notices for both in-network and out-of-network services posted below.
Fees and payment: Our practice fees are listed below. We offer a free telephone consultation prior to your appointment and are happy to discuss fees over the phone or in person during our first session if you would prefer.
- $210 for a 60 – minute initial evaluation
- $180 for a 55 – minute individual session
- $190 for a 55 – minute couples or family session
- $125 per hour for additional services (e.g. report writing, treatment summaries)
- $200 per hour for legal services (e.g. preparation of materials, attendance at hearings)
Payments are required at each session, and we accept cash, personal or cashier’s checks, Zelle money transfer or payment via your banks “bill pay” system. We do not accept credit card payments or other money transfer systems (e.g. Paypal, Venmo).
Insurance: Malouf Counseling and Consulting is credentialed with Carefirst/BCBS (PPO, POS, HMO and Federal plans) and JHH EHP (only Dr. Malouf accepts EHP). However, if you have a different insurance plan and it offers out-of-network benefits, you should receive some reimbursement for the cost of services. Most insurance companies that provide out-of-network benefits cover between 50%-80% of the cost per session. We are happy to provide the necessary documentation for you to receive reimbursement for services. We recommend that you contact your insurance provider and inquire about your “out-of-network” benefits (see instructions below).
Primary vs Secondary: Please let us know if you have a primary/secondary plan (i.e. if you have two insurances or are covered under someone else’s insurance in addition to your own). This may impact how we process your claims.
In-network insurance basics (BCBS/EHP only):
If you are using BCBS or EHP insurance, it can still be helpful to contact your insurer to determine what costs you will be responsible for. In some cases the cost may be nothing and in others it can be over a hundred dollars per visit. Typical costs include:
- Deductible: the amount you have to pay out-of-pocket before your insurance begins paying for your visits (can range from a few hundred to thousands, but may not always apply to routine mental health visits)
- Copay: a flat cost you pay for each visit (typically ranging from $0-$50 regardless of the total fee for the visit)
- Coinsurance: a percentage cost of the total visit fee you pay in lieu of a copay (typically ranging from 0%-20% of the total fee for visit)
As an example, let’s assume someone has a $2000 deductible that applies to mental health services and a $20 copay. If they saw a mental health provider who is in-network at a rate of $200 per visit, the individual would end up paying $200 for each of the first ten visits (until they met their $2000 deductible). Afterwards, they would pay $20 per visit and insurance would reimburse the provider for the rest. However, if the deductible does NOT apply to mental health, they would just pay $20 from the beginning.
Note that the deductible typically applies to ALL your other doctor visits. Using the same example as above, if the individual previously had a medical procedure costing $1200, they would only have $800 left on their deductible. As such they would only pay the full fee for the first four visits (i.e. $800). After that they would pay their $20 copay for each session.
In either of these cases, if the individual has a coinsurance instead of a copay, their fee is calculated a little differently. For example, if they have a 20% coinsurance, they would pay 20% of the total charge each session. Using the example above that would be $40 out of $200 for each visit. Similar to the copay, the coinsurance only applies once the deductible has been met.
Finally, please know that deductibles restart with your plan year (typically in January, though depending on your plan, it might be a different time). At that point, regardless of what has already been paid, you will have to pay out-of-pocket until the deductible is met again.
Out-of-network questions to ask your insurance company about your mental health benefits:
- Do I have out-of-network mental health benefits?
- What amount will I be reimbursed for the following services with a licensed psychologist?
- CPT Code 90791 (initial consultation) at a fee of $210.
- CPT Code 90837 (subsequent psychotherapy sessions) at a fee of $180 per session.
- If they do not reimburse the above code, how much do they reimburse 90834 (subsequent psychotherapy sessions) at a fee of $180 per session.
- CPT Code 90846 (couples or family therapy) at a fee of $190.
- NOTE: if you are seen by Zack Aaron, M.S. or Franny Parent, M.S. be sure to ask if “incident-to” billing is permitted, i.e. if they will reimburse for sessions with a registered psychology associate practicing under Dr. Malouf’s supervision.
- Is there a deductible I need to meet each year before I can begin to receive reimbursement for sessions and is it different for out-of-network providers?
- Is there a session limit per year?
- Is there pre-authorization required? If so, what information do you need for this? Is there a specific form that needs to be filled out?
Good Faith Estimates
In January 2022, the “No Surprises Act” went into effect. The intent of the bill is to prevent individuals from being charged inappropriately by providers who are not in their network.
One way this can happen is if you go to an in-network hospital or center for a treatment but one or more providers on their treatment team (e.g. an anesthesiologist, a second surgeon) doesn’t actually take your insurance (i.e. is out-of-network). They could be a contractor who isn’t actually employed by of the hospital or may be an employee who hasn’t completed their insurance credentialing (onboarding) yet. This bill requires that you be notified in advance to prevent you from being billed by these people unfairly. See here for more information: No Surprises INN
Another way this could happen, is if you go to an out-of-network hospital or center for a treatment and even though you know they don’t take your insurance you don’t know how much they will charge you for the service. When meeting with a psychologist in an outpatient practice like ours, it is pretty simple to tell how much you will be charged since we typically charge an hourly rate and limit each session (procedure) to an hour… but for other medical procedures that require lots of supplies, overnight stays, additional providers, etc., it can be less clear. This bill requires that you be notified of ALL the charges you will receive as part of any given procedure. This is called a Good Faith Estimate. See here for more information: No Surprises ONN