Rates, Insurance, Payment
Answers to common questions about costs and payment options. Please feel free to call or reach out using the Contact page as well.
Insurances Accepted by
J. Higgins Counseling:
- Independent Health
- Highmark Blue Cross Blue Shield of Western New York (or any commercial line of BCBS)
- Univera
- Aetna
- Nova Healthcare Administrators (affiliated with Independent Health)
- Meritain (an Aetna company)
- Medicaid and Medicare are not accepted, even if managed through these or any other companies.
Coverage varies by therapist
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Fee Schedule
Services are billed at the following rates:
$150 for Psychotherapy, 60 minutes (53 or more minutes)
$120 for Psychotherapy, 45 minutes (38-52 minutes)
What forms of payment are accepted?
Accepted forms of payment are cash, check, credit/debit card, and Bitcoin. Health Savings and Flexible Spending Accounts are often able to be used as well. Auto-payment by credit card is available. Many people choose to use insurance benefits for these services. Please see below for information about insurance.
In-Network vs Out-of-Network Insurance
J. Higgins Counseling, LCSW, P.C. is in-network with some insurance and works with many others on an out-of-network basis. There are trade-offs for both. In-network can offer a referral directory to aid in finding a provider and may lower out-of-pocket costs. Out-of-network treatment allows greater freedom in choosing your provider. Either way, your benefits will be determined by your individual plan.
How does In-Network coverage work?
Your in-network benefits for outpatient mental health treatment will apply. This includes any applicable deductible or cost sharing such as copay or co-insurance.
How does Out-of-Network coverage work?
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. Full session fee is paid at time of service and then reimbursed according to plan benefits. 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.
Example of Out of Network benefits
Let’s say your insurance reimburses 75% up to an allowed amount of $100 for a 45 minute session (CPT code 90834) with a clinical social worker (LCSW). You would be asked to pay full session fee of $120 at time of service, then receive a “Superbill,” give that to your insurance company, who would reimburse $75 (they only reimburse the percentage up to the allowed amount), leaving you with a total of $45 out of pocket cost. 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? The following information about credentials and CPT codes may be referenced if needed: Licensed Clinical Social Worker (LCSW) or Licensed Mental Health Counselor (LMHC). 45 minute psychotherapy CPT 90834 = $120, 60 minute psychotherapy CPT 90837 = $150
Insurances Accepted by
J. Higgins Counseling:
- Independent Health
- Highmark Blue Cross Blue Shield of Western New York (or any commercial line of BCBS)
- Univera
- Aetna
- Nova Healthcare Administrators (affiliated with Independent Health)
- Meritain (an Aetna company)
- Medicaid and Medicare are not accepted, even if managed through these or any other companies.
Coverage varies by therapist