Do we accept insurance?
We function as group of private psychotherapists working together under one name, NYC Therapy Group. What this means is that whereas one therapist may accept your insurance, others in our practice may not. Currently, some of our therapists are “in-network” with the following insurances:
– Empire BC/BS
Primarily, we offer service on an “out-of-network” basis. What does this mean? Well, depending upon your insurance provider, your therapy at NYC Therapy Group may be partially reimbursable through your insurance provider. While just a few of our therapists are “in-network” with a few insurance providers, most of our therapists are considered “out-of-network” providers and can provide services on a sliding scale basis if need be.
What is the difference between “In-Network” and “Out-of-Network”?
“In-network” means that a contract exists between a therapist and the insurance company in which the insurance company will pay the therapist directly a set fee for the service provided which may or may not include a “co-pay” on behalf of the client, which accounts for a smaller portion of the set fee. In this case, there may be a deductible which is a set amount of money that needs to be met (paid out by the client) before the insurance provider begins to cover their portion of the fee, which means the client may be responsible for the full fee until the deductible is met.
“Out-of-network” means that there is no contract between a therapist and insurance company and the client is fully responsible for the therapist’s fee for the service provided. Then, once the fee is paid, your therapist will provide you with a receipt indicating your payment and other necessary information (such as therapists’s license number, procedure code for service rendered and a diagnosis code) for you to submit to your insurance company to request reimbursement for a portion of the fee. Although a majority of insurance providers do provide some reimbursement for “out-of-network” services, reimbursement rates differ on a case-by-case basis.
In either instance, it is important for you, the client, to be informed about your insurance coverage by calling your insurance company prior to seeking therapeutic services and ask the following questions:
1) Do I have coverage for “out-of-network” mental health services?
2) If so, do I have a deductible?
3) What percentage of the session fee is covered ?
3) How many sessions are covered per year?
4) Do I need pre-authorization for mental health services?
5) Does the insurance company establish an expected session fee on which they base their reimbursement rate?
Your insurance company may ask you if you have a procedure or CPT code for the therapy you wish to receive. If asked, you may give them the following information for the types of services we provide and ask what their rate of coverage for each code is:
CPT code 90791 is for the initial consultation/intake
CPT code 90837 is for a 60 minute therapy session
CPT code 90834 is for a 45 minute therapy session
CPT code 90853 is for a Group therapy session
If you have any additional questions about how to navigate your insurance, please call us. We are happy to assist with this process.