At Provenance Counseling and Wellness, LLC, clients can pay for services using in-network insurance benefits, out-of-network benefits, or pay out-of-pocket on their own. Here are some ways to determine if insurance will support your counseling experience.

 

Private-Pay

Individuals who do not have insurance or who prefer not to use insurance have the option to pay for counseling sessions out-of-pocket at the time of service.

 

In-Network (INN)

This means your counselor is contracted with your insurance provider and can accept payment at the agreed upon contracted rate with your provider for services. To help you make an informed decision on using these benefits, you’ll need to contact your health insurance provider and ask:

1. Does my health insurance plan include mental/behavioral health benefits?

2. Do I need preauthorization before beginning counseling? Will you assist me with that process?

3. Does my PCP need to provide a referral for counseling?

4. Do I have a deductible? If there is a deductible, have I met it yet?

5. Once I have met the deductible, what is my co-pay/coinsurance amount?

6. Does my plan limit how many sessions per calendar year I can have? What is the limit?

 

 

Out-of-Network (OON)

This means that your counselor is NOT contracted with your health insurance provider, and you must pay the full fee at the time of service. The counselor will provide you with a superbill (itemized receipt for services) that you may submit to your provider for possible reimbursement. Note that reimbursement from your provider is not guaranteed. Here are some questions to verify and ask your health insurance provider regarding out-of-network benefits:

1. Do I have out of network benefits for mental/behavioral health?

2. Do I need to get preauthorization? If so, can you start that process with me?

3. Do I need a referral from an in-network provider to see an out-of-network provider?

4. Do I have an out of network deductible? If so, what is it? How much of it has been met?

5. What is my policy period? Is there a limit to how many sessions I can have within the policy period?

6. After my deductible has been met, what is my coinsurance?

7. How do I submit claims for reimbursement? How long do I have to submit my documents for reimbursement?

 

When using in-network and out-of-network insurance benefits, counselors are required to provide clients with a diagnosis as well as cooperate with insurance providers’ requests for records regarding treatment and progress.