Questions and Answers about Mental Health Insurance for Counseling

At Pediatric and Adult Behavioral Counseling, we accept HSA, BCBS, BCN, Aetna, United Health Care, Oxford, Oscar Health and private pay. We are unable to accept Medicaid or Medicare at this location. You can view our private pay rates here.

Coverage and benefits for traditional therapy and counseling services change from one health insurance company to another and from plan to plan, but generally the following rules apply:

  • Coverage for mental and behavioral health services depend on your insurance plan and coverage for mental health services. Please call your insurance provider to verify your benefits.
  • Reimbursement for mental and behavioral health services for out of network providers depend on your insurance plan and coverage for mental health services. Please call your insurance provider to verify your benefits.

Pediatric and Adult Behavioral Counseling currently accepts HSA, BCBS, BCN, Aetna, United Health Care, Oxford, and Oscar Health for telehealth and office appointments. We are unable to accept Medicaid or Medicare at this location.

If you consider using your health insurance, please check with your insurance company by carefully by asking the following questions:

  • Do I have mental and behavioral health insurance benefits?
  • What is my deductible and has it been met?
  • What is my copay for mental and behavioral health services?
  • What will my out of pocket costs be per visit?
  • How many sessions per year does my health insurance cover?
  • Do you reimburse or cover anything for out of network providers?
  • My behavioral health / mental health provider has a SuperBill for out of network providers, can I submit for reimbursement?

The basic codes are as follows:

  • 90871
  • 90832
  • 90837
  • 90834
  • 90846
  • 90847

Out of Network usually refers to physicians, hospitals or other healthcare providers who do not participate in an insurer’s provider network. This means that the provider has not signed a contract agreeing to accept the insurer’s negotiated prices.

According to depending on an individual’s health insurance plan, expenses incurred for services provided by out-of-plan health professionals may not be covered, or may only be partially covered by an individual’s insurance company. Plans that cover out-of-network care are less common than they once were, but they are still available in many areas. They generally impose a higher deductible and out-of-pocket limit (or even no upper limit) when patients obtain care from an out-of-network provider.

And it’s important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share. In-network providers have agreed to accept the insurance company’s payment (plus the patient’s pre-determined cost-sharing amount) as payment in full, but out-of-network providers have not signed any sort of agreement with the insurer.

Some companies like Chrysler have BCBS medical coverage for employees, but mental and behavioral health benefits are covered under a third party - Beacon Health. Please note that for your services to be covered, your counselor must accept Beacon Health or are considered out of network and you will be responsible for out of pocket fees. Pediatric and Adult Behavioral Counseling is not a provider for Beacon Health.

For those that are out of network, we provide SuperBills so that you may submit to your insurance company for reimbursement of services. Essentially, a Superbill is an itemized list of all services provided to a client. You pay up front for services and your insurance company may reimburse you. Some insurance companies will cover a percentage of services provided by out of network providers. It is important to contact your insurance company to see if this applies to your benefits prior to starting services.

Please be sure to cancel or reschedule your appointment within 24 hours of your appointment with your clinician directly or our main office to avoid full charge of appointment via text, phone or email. Intake appointments are charged $200 for no show or late cancellations. Please note that insurance does NOT cover the cost of missed appointment fees and the card on file will be charged.

We assess a $35 late fee for every 30 days an invoice is past due.