Before we talk about how to ask, you need to know some basic language. Anytime insurance receives a claim, they look for two things.

1. A diagnosis code
   Insurance companies operate off of “medical necessity.” That means they only pay for things they think you absolutely need, not just things you want. A diagnosis code is the sequence of numbers that tells them what you are having treated.

2. A CPT code
   The CPT code is the sequence of numbers that tells the insurance what procedure the clinician is doing to treat the diagnosis. For example, there are different CPT codes for when a doctor removes a wart as opposed to when they remove a skin tag.

The combination of those things will determine if they pay the claim. They may cover a diagnosis but not a particular CPT code. They may cover a CPT code but not to treat certain diagnoses. So, here’s how to ask about reimbursement.

If you are coming in to counseling by yourself, this is the right section.

Once you reach a customer service agent, let them know you have questions about out of network coverage. Ask them the following questions.

1. Do you reimburse for CPT code 90834? This is the CPT code for basic individual counseling sessions.

2. Do you reimburse for diagnosis code F43.20? This is the diagnosis code for a general adjustment disorder. We cannot diagnose you without doing an assessment. At the same time, most clients who come in would qualify for this so it is a safe one to ask about. If they will reimburse for this, they will typically reimburse for most common mental health diagnoses.

If you call and ask your insurance just that question, they’ll typically say yes. But that likely doesn’t mean what you think it does. They’re likely talking about situations where you may sit in on a session to support your partner as they are treated for an individual issue (like a bipolar disorder, anxiety, depression, etc.). It would be insurance fraud to file this type of claim for reimbursement when in reality you are both in session together as equal participants and working on relational issues, not an individual issue. However, there are some insurance companies who recently have shown a willingness to reimburse for actual relational/couples/marriage counseling.

To find out if yours is one of them, call the number on the back of your card, ask for benefits information and then specifically ask these two questions.

1. “Do you reimburse for procedure code 90847?” This code indicates that there are two of you in the counseling office at the same time.

2. “Do you reimburse for diagnosis code Z63.0?” This code more accurately reflects what is happening and what will be the focus of counseling, i.e., “Relationship Distress with Spouse or Intimate Partner.”

In short, because we treat our intake sessions as intakes while many other places treat those more consultation and paperwork time. You might spend 15 minutes of your free 50 minute intake session filling out paperwork which the therapist then takes time to review. You end up with perhaps 20 minutes of talking before scheduling your next session.

Our intakes are different. We’ve already met you in the consult. Our secure client portal means you're able to fill those items out at your convenience rather than rushing because your appointment time is ticking away. It also means your therapist reviews your paperwork ahead of time instead of burning your appointment reading your questionnaire for the first time.

All of this means we can sit down, touch on just the legal and ethical points we’re required to review in person, and then spend the bulk of your 90 minute intake actually getting the process started.

All of our clinicians offer a limited number of sliding fee slots in their caseload. These are available on a first-come, first-served basis. We also frequently have clinical interns on staff who are able to offer lower fee services than our other clinicians. They are also able to take on more sliding scale clients than our regular clinicians.

To inquire about these sliding scale slots, contact us directly.

Counseling is expensive because you are working with highly trained professionals, the mental health equivalent of a nurse practitioner. We are here to help you to heal from the issues you are experiencing and become the best you that you can be. Don’t let the cost of counseling or therapy services scare you away. This is an investment in your and/or your relationship’s immediate health and long-term well-being.

This is a really common question and one that doesn’t have an easy answer. Some people come in, dig deep on one specific thing, and wrap up their work in six or 8 sessions. Others come in with a number of challenges that have been going on for years or decades and that takes time to address.

Our goal isn’t to keep you in therapy forever. Our job is to work ourselves out of a job by helping you meet your goals, make the changes you are wanting, and help you move forward in your life.

Most people have more questions before starting this process, especially if it is their first time seeing a counselor. You can check out our Frequently Asked Questions page for many common questions. You can also just give us a call or send us a message. We return all messages and strive to do that within one business day and we’re always happy to answer any questions.

Yes, absolutely. We have quite a few clients who do this.