Rates
Rates will be discussed during the phone consultation. Phone consultations are free.
No Surprises Act: Good Faith Estimates
Acording to the No Surprises Act, as of January 1, 2022, health care providers, including mental health care providers, are required to give uninsured and self-pay patients, including clients who have insurance that is out-of-network, a Good Faith Estimate of expected charges/costs for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.
McGowan Family Counseling will provide a Good Faith Estimates for any self-pay clients, including uninsured clients and clients whose insurance is out-of-network, and for any in-network clients upon request. Oral Good Faith Estimates will be shared during the initial phone consultation, when the client is scheduled, or when the client asks about costs.
According to the Act, McGowan Family Counseling will also provide a formal Good Faith Estimate in a written document, which is detailed in the mandated timeline outlined below:
- If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;
- If the service is scheduled at least ten business days before the appointment date, no later than three business days after the date of scheduling;
- If the client requests a Good Faith Estimate without scheduling a service, no later than three business days after the date requested; and
- If any information in the estimate changes, a new Good Faith Estimate must be provided no later than one business day before the service. If a change occurs less than one business day before the service, McGowan Family Counseling must accept the original Good Faith Estimate.
Insurance
Services may be covered in full or in part by your health insurance or employee benefit plan. Covered insurance plans are BlueCross BlueShield of Illinois (BCBS) PPO. Blue Choice is not in-network. It is in your best interest to verify the details of your health insurance policy. It is recommended that you verify your coverage at least 48 hours prior to the first appointment to make sure that I am a covered provider and these services will be covered.
Please check your coverage carefully by asking the following questions:
- Do I have mental health insurance benefits?
- What is my deductible? Have I already paid any of my deductible?
- How many sessions per year does my health insurance cover?
- What is the coverage amount (co-pay) per therapy session?
- Are there any limitations to services (e.g., only a certain amount of money allowed for mental health reimbursements, a limited number of sessions, reimbursement only for certain types of diagnoses, etc.)?
- What are my out-of-network outpatient mental health benefits? How much of each therapy session will your insurance provider reimburse (typically a percentage)? Do I need to meet a deductible before my benefits begin paying for out-of-network providers? Where do I mail my receipt? How long will it take to be reimbursed after I mail my receipt?
- Is approval required from my primary care physician?
If I am not an in-network provider for your insurance, I am also an out-of-network provider for all other insurance plans. You may have an out-of-network benefit, which allows you to see any therapist, pay directly, and then be partially/fully reimbursed by your insurance provider. McGowan Family Counseling can provide you with a superbill (detailed receipt) for you to submit to your insurance company for reimbursement. Many insurance companies will cover 50-100% of my fee as an out-of-network provider. If I am an out-of-network provider for your insurance, you will be expected to pay the full fee at the time of services rendered. Many people have excellent out-of-network mental health benefits and can actually end up paying less per session (after deductible is met) than a co-pay for an in-network therapist. For example, your co-pay for an in-network therapist may be $25 per session, but for an out-of-network therapist your insurance may cover 80-90% of the session, which may end up only being a co-pay of $20 per session.
Most insurance companies require you to authorize your therapist to provide a clinical diagnosis, which will become part of the insurance company files. Although all insurance companies claim to keep such information confidential, once they have the information, McGowan Family Counseling has no control over its use. It is important to note that, by submitting for insurance reimbursement, you are in essence creating a diagnosis in your and/or your family’s medical record(s) that insurance companies may use in the future to determine coverage; however, the Affordable Care Act may mitigate this concern. You remain personally responsible for deductibles, co-payments, coinsurance, non-covered, ineligible, or unauthorized services.
Many individuals who have health insurance elect not to use it for coverage of mental health services, and instead pay for therapy as an "out of pocket" expense, or use their Health Savings Account (HSA) or Flexible Spending accounts. Most often, this is due to concerns about the privacy of their health information, and the potential release of this information to health insurance companies and their affiliated entities.
*Important Note about Using Insurance (BCBS PPO)
For clients in-network with Blue Cross Blue Shield PPO (BCBS PPO), co-pays and deductibles are due at the time of service. If, for any reason, your insurance denies your claim, you are responsible for the entire cost of the session.
Payment
Cash, check and all major credit cards, are accepted methods of payment. Payments can also be made through the secure client portal.
Payment for Other Services
Phone conversations, emails and any other form of communication that require more than 5 minutes will be billed on a prorated basis at my regular fee. You will be also charged my regular fee on a prorated basis for other professional services offered, such as report writing, attendance at meetings, consultations with other professionals which you have authorized, preparation of records or treatment summaries, reviewing records/reports, or any other service you may request.
Schedule Online
Request a therapy appointment online here.
Contact
Questions? Please contact me for further information.