Rates, Payment & Insurance
Answers to common questions about costs and payment options. Please feel free to call or reach out using the Contact page as well.
In Network vs Out of Network
J Higgins Counseling is in-network with some insurance and works with many others on an out-of-network basis. There are advantages and disadvantages to both. In-network can offer referrals or lower out of pocket costs. Out-of-network treatment allows greater freedom from certain limitations. In particular, limitations often include the types of treatment allowed, the amount of sessions allowed, and the confidentiality of your personal information. With out-of-network care, treatment is determined by the therapist and recipient without a third party being involved in the treatment process.
Most insurance companies offer out-of-network coverage for services provided by licensed professionals. This means they will allow members to go out-of-network for mental health care and then provide reimbursement. Your insurance company can answer a few simple questions that will help you decide if this is the best choice for you. More information and an example are below.
J Higgins Counseling is a participating provider with BlueCross BlueShield of Western New York and with Independent Health.
Out of Network
Full session fee is paid at time of service. Auto-pay is available and can be set up with a credit or debit card. Sometimes HSAs (Health Savings Accounts) or FSAs (Flexible Spending Accounts) can be used as well. Most insurance companies offer partial reimbursement with the amount depending on your individual plan. You can request reimbursement by submitting a special receipt called a “Superbill” (that's really what its called) which J Higgins Counseling can provide at your request or they can be accessed through secure client portal.
How do Out of Network benefits work?
Let’s say your insurance reimburses 75% up to an allowed amount of $100 for a typical 45 minute session (CPT code 90834) with LCSW-R.
You would be asked to pay full session fee of $120 at time of service, I would provide a “Superbill” for you to give to your insurance company, then your insurance company would reimburse $75 (they only reimburse the percentage up to the allowed amount), leaving you with a total of $45 out of pocket cost per standard session.
Contact your insurance company with the following questions:
Do I have out-of-network mental health benefits?
What percentage am I reimbursed for routine outpatient mental health office visit?
What is the allowed amount (sometimes referred to as Usual Customary Rate or UCR)?
Do I have a deductible? If so, how much of it is already met?
You can provide the credential and CPT codes listed below if it is helpful
Licensed Clinical Social Worker (LCSW-R)
45 minute psychotherapy CPT 90834 = $120
60 minute psychotherapy CPT 90837 = $150
What forms of payment are accepted?
Cash, check, or credit card. Health Savings and Flexible Spending Accounts are often able to be used as well. Plan to add Bitcoin in the future...I would like to better understand the level of interest in this payment method. Please feel free to drop me a line using the secure contact page if you want to express interest. Autopayment is available if desired. Invoices, Statements or Superbills can be automatically generated and emailed to you or retrieved from the secure online portal.
Services are billed at the following rates:
$150 for Psychotherapy, 60 minutes (53 or more minutes)
$120 Psychotherapy, 45 minutes (38-52 minutes)