Insurance 101

Carolina Growth and Wellness, PLLC is a fee-for-service practice. Payment is due in full at the time of your session. However, you are able to use out-of-network benefits if you have them. This means that you may receive reimbursement for therapy services if you file claims directly with your insurance company.

Why you might NOT want to use your insurance

Insurance REQUIRES that I give you or your partner a medical diagnosis

Insurance companies only pay for things that are “medically necessary.” This means that I would have to diagnose you with a mental health disorder (Depression, Anxiety, Adjustment Disorders are examples). Many of life’s problems are not mental health disorders, especially marriage issues. I do not want to diagnose you or your spouse with a disorder just to satisfy insurance requirements. Having a diagnosis on your record may impact your ability to get certain kinds of jobs and obtain life insurance. You need to ask yourself if you want a mental health diagnosis in your record if you don’t need it.

Loss of Confidentiality

I am committed to providing you with the best, safest, and most confidential services that I can. Insurance companies interfere with this. Insurance companies require treatment plans, progress reports, and many other types of personal information to determine what, if anything, they will cover. I believe these details should be private, but instead they are open and available to anyone with access.

Insurance Companies have a lot of power

Insurance companies only approve a certain number of sessions, even if more are necessary. It could take months to get reimbursement, if at all. Insurance companies can say who can be a part of treatment. They can tell you something is covered and then deny it anyway, which still leaves you responsible for the remaining fees.

I believe these decisions are up to me and you to decide. It really is no one else’s business and you are the expert on how long you need therapy, not the insurance company.

Insurance Companies make it difficult for me to get paid

Insurance companies do not pay providers their set fee. They get to decide on how much they want to pay the provider. In most cases, they pay 65% or less of what a provider’s set fee is. Some insurance companies take months to pay the provider and it is very unfortunate, as many of us are small business owners. I also provider 75-90 minute couples sessions and insurance companies will only reimburse for up to 60 minutes most of the time. The time spent communicating with the insurance company would leave me less time to provide consultations, collaborate with other providers, attend trainings, and be available for your needs.

So, How Does A Couples Therapist Accept Insurance?

The therapist will typically have to diagnose you or your partner with a mental health disorder, and then state that the other person is there in support of the partner.

One of you will be labeled the “patient.” I believe doing this unbalances the treatment and pathologizes the partner who is the “identified patient.” One partner should not feel blamed for relationship issues. Marriage issues are best seen as something that the couple wants to solve together.

What Else Can I Do?

Pre-Tax Dollars

You can use your Health Savings or Flexible Spending Accounts to pay for therapy using pre-tax dollars. I accept all types of HSA and FSA cards with major credit card logos on them. If you do not have one of these accounts, you could speak with your tax preparer to see if you could deduct therapy expenses from your taxes as an out-of-pocket health expense.

Seek Lower Cost Therapy

I do offer a sliding fee scale for some clients. Please contact me regarding this.

Do more research

I encourage you to investigate all options and arrive at an informed decision regarding your health care BEFORE using your benefits. That may mean using your insurance, and it may mean making another choice.

If you choose to use “Out-of-Network” Insurance Benefits:

The amount that insurance will reimburse for “out-of-network” services varies by plan. If you want to use your out-of-network benefits, I recommend you call the number on the back of your insurance card.

When speaking to a representative, remember that:

-Different services are reimbursed at different rates

-Know your deductible! Even if you use a provider that is in-network, you may have to meet a deductible before they begin to cover your treatment

-Some services may not be covered

-Ask about the exact reimbursement rates for an “out-of-network” provider

Here are the most common codes you should ask if your plan will reimburse you for:

90791 Diagnostic Evaluation 90847 Family or Couples, with patient present
90837 Psychotherapy, 60 minutes 90846 Family or Couples, patient not present

I will give you a receipt to mail/ fax to your insurance company that meets their requirements. Sometimes you can even submit a claim online.

It’s your choice!

This information can be devastating or shocking for some, and not a big deal to others. You are the only person who can decide what is right for you. I want to make sure you have all the information you need to make an informed decision.

Please contact me with any questions or concerns you may have.