INSURANCE AND FEES

PLEASE NOTE:
TCG has a medical biller on staff to inquire about client benefits and eligibility.  The information received from the insurance company is not a quote of benefits.  It is the client’s responsibility to contact the insurance company to verify benefits and eligibility prior to their Initial Appointment.

The following information pertains to all clinicians at TCG EXCEPT for Justin Tobin, LCSW.  Justin is out of network with all insurance companies.

What insurance plans are you considered an in-network provider?
We are an in- network provider with Blue Cross Blue Shield PPO and Aetna PPO.  We are considered out-of- network providers with most other insurance plans.

How much will my therapy session cost if I DO use BCBS PPO or Aetna PPO?
This depends on your group plan and your benefits plan.  Contact your benefits administrator or the insurance company for this information.

Here is a list of questions that you may find helpful when you contact your insurance company:

• Do I have mental health benefits?
• What is my co-pay/co-insurance for each therapy session?
• Do I have a deductible? What is the total dollar amount?  What dollar amount is remaining for this calendar year?
• Are the following CPT codes covered under my plan?
  • 90791 (Initial Appointment/Diagnostic Evaluation)
  • 90834 (individual therapy appointment for at least 38 minutes)
  • 90837 (individual therapy appointment for at least 53 minutes)
• Do I have a carve-out to another insurance company? If so, what is the insurance company?
• If you have more than 1 health insurance plan, which plan will be considered the primary plan?

Do I have to submit claims to insurance?
No.  If we are in-network with your insurance plan, then we will submit insurance claims on your behalf.  We will collect from you the patient responsibility portion as stated on the claim.

If I have BCBS PPO or Aetna PPO, how do I know if it is a PPO plan?
This information is often located on your insurance card. If it is not located on your insurance card, contact the customer service phone number listed on your insurance card to verify this information.

How much will my therapy session cost if I DO NOT have/use BCBS PPO or Aetna PPO?
If your insurance is out of network, if your therapy sessions are not a covered benefit or if you choose not to use your health insurance, you will be responsible for the cost of the therapy session. Please note that some insurance plans offer out – of -network reimbursement and we are happy to provide you with a receipt with all the necessary information.  Below, the range is provided, but the specific cost of each therapy session is based on the provider.  Please contact our office for specific rates.

• Initial appointment: $180-$200
• Individual therapy: $180-$200
• Couples/family therapy: $200

Are you considered in-network with Medicare or any HMO insurance plans?
No, we are not considered in-network with Medicare nor any HMO plans.

What is the process if I don’t use health insurance or if I choose to pay out of pocket?
First, contact your insurance company to find out your out of network benefits. You are welcome to use the questions above to collect this information.   At the time of the session and once payment has been made to our office, you will then be provided with a Receipt with all the necessary information for you to submit to your insurance company.  Some (not all) insurance plans do offer coverage for out of network services.  You will also want to understand their process on how you should submit these Receipts for reimbursement (this is usually done on-line and possibly via an insurance company patient portal you may have created when you first signed up with your group plan).

What if I have more questions?
Please feel free to ask us anything insurance related during the Free Consultation.  If you have questions about your insurance and would like to talk prior to scheduling the Free Consultation OR you are an existing client, please do not hesitate to email or call us as we are happy to help.