DFWLPC Psychotherapy

Frequently Asked Questions

Directions: How do I find the office?

We are located at 500 NORTH CENTRAL EXPRESSWAY, STE 500, PLANO, TX 75074 in the “Central Five Hundred” office building on the North-East corner of Hwy 75 and N President George Bush Turnpike.

Enter the building, take the elevator in the main lobby to the 5th floor. Step off the elevator to the left and have a seat in reception. If there is no receptionist on duty, please text me at 972-848-6060 and I will collect you from the lobby.

Approximately:

5 mins from Richardson

14 mins from Garland

16 mins from Carrollton

18 mins from Addison

22 mins from Frisco

24 mins from The Colony

24 mins from Downtown Dallas

Public transit CityLine/Bush Station (Red & Orange lines) are directly south of us just on the other side of "N President George Bush Turnpike" within walking distance.

Appointments: How to Schedule / What about Emergencies?

Thank you for trusting DFWLPC LLC with your behavioral health needs.

To schedule an appointment, please click the "Schedule Appointment" button. If you have questions before you schedule, please email us at INFO@DFWLPC.COM and we will respond the following business day.

Please complete all forms in your client portal 24 hours before the date of your appointment.

Please arrive 5 minutes prior to your appointment.

After Hours Policy / Emergencies:

In an emergency situation, please call 9-1-1 or [Click Here for CRISIS Contacts]

If you need to contact your therapist, you may do so by emailing or leaving a message and it will be forwarded to your therapist. We are not a crisis facility and are not responsible for any damage occurring as a result of unmet crisis or acute care needs. Non-emergency phone calls will be returned the following business day. 

Note: Communication outside of sessions is limited to administrative matters.

Cancellation Policy: What if I miss my appointment?

Missed Appointment fee: $75

Your appointment time is reserved specifically for you. Please be courteous, and when at all possible, provide as much notice as you can. If you must cancel or reschedule an appointment, we ask that you provide notice of at least 24 hours.

If you do not cancel prior to 24 hours of your appointment, fail to show up, or are more than 14 minutes late, this will be considered a missed appointment and you will be charged a $75 fee. Please note, Insurance companies will not reimburse missed appointment fees and any fee incurred due to a missed appointment will be your responsibility.

EXEMPTIONS: The only exemptions to this cancellation policy are serious or contagious illness (with physicians note) or emergency or other reason deemed appropriate to waive fee. The death of a family member, natural disaster, or severe weather conditions, all qualify as emergencies. Other reasons may be considered at the discretion of the practice on a case-by-case basis. However, a business meeting, final exam, another appointment, minor illness, sleeping in, would NOT qualify as an exemption for an excused appointment.

* Courtesy reminders are available by text or email. Please note: regardless of any reminder you request, you are accountable for your appointment time and any associated fees for missing an appointment. 

To cancel an appointment please use your client portal, or send us an email with the subject "Cancel" INFO@DFWLPC.COM.

Payment: How do I pay for my sessions?

DFWLPC is a private pay out-of-network provider but for insured clients we partnered with Grow Therapy to serve your needs. If you wish to use insurance, you can schedule a session through Grow Therapy using this link. However, if you have out-of-network mental health benefits not covered by Grow Therapy and still wish to use insurance, we provide you with a superbill receipt to file with your insurance company for reimbursement.

All payments are due and billed on the date of service PRIOR to services rendered. If payment is declined for any reason, your session may be canceled.

We accept:

* All major debit and credit cards.

* HSA/FSA cards (must be accompanied by debit/credit card).

NOTE: All payments are processed securely through our payment processor SimplePractice. DFWLPC LLC has the required medical MCC or Merchant Category Code added to our account but we cannot guarantee that one of these cards won’t be declined. If you aren't sure why a card was declined, we recommend contacting your bank or card issuer for more information. We often see that having a client submit a specific request to their financial institution to have charges approved clears up future charges.

We do NOT accept:

* Cash

* Checks

* 3rd party reimbursement (insurance companies, governmental payers like Medicare, employers self-insured plans)

If after 30 days your account is not paid, we may assign your account to an outside collection agency.

Does DFWLPC LLC accept Insurance?

No, we are considered out-of-network for all insurance companies. Our standard is to provide each client with the highest quality of personalized care in a private and safe space free from insurance limitations.

DFWLPC is a private pay out-of-network provider but for insured clients we partnered with Grow Therapy to serve your needs. If you wish to use insurance, you can schedule a session through Grow Therapy using this link. However, if you have out-of-network mental health benefits not covered by Grow Therapy and still wish to use insurance, we provide you with a superbill receipt to file with your insurance company for reimbursement.

Healing properly takes the time that it takes, everyone is different!

Clients are often surprised to learn they can seek reimbursement for out-of-network mental health services and that benefits might be equal to or better than in network.

We encourage everyone to consider submitting reimbursement for the sessions if privacy is not a concern. You can request a superbill after each session that you can submit to your insurance for reimbursement according to your benefits.

What is a superbill?

A "superbill" is a special receipt needed when seeking reimbursement from your insurance company and possibly your employer, or health care savings account (HSA). We leave it completely up to you if you want a just a simple receipt or superbill receipt, and we are happy to provide either upon request!

A superbill is basically a detailed invoice with specific information required by an insurance company normally used to file a claim for reimbursement. The superbill will contain many things such as the CPT Code and an itemized list of services you received from your therapist (i.e. out-of-network provider) and the amount you paid.

How can I use insurance if my therapist is private pay (out-of-network)?

You may manually submit claims to your insurance company for reimbursement. Always call your insurance first to verify if your plan covers mental health. Be sure to ask about costs for out-of-network providers for both in-person and virtual sessions because sometimes insurance companies treat them differently!

Therapists that are “Private Pay” or "out-of-network" can provide you with a superbill (upon request) after each session. You use that to submit a claim to your insurance company to seek reimbursement at the out-of-network rate for the sessions.

Here are the common steps to submit an out-of-network claim for reimbursement but confirm with your insurance company:

  1. Print and complete the out-of-network claim form (usually on the insurance companies website).

  2. Attach superbill receipt for services rendered and proof of payment.

  3. Send the claim form with the superbill receipt to the insurance company (usually they ask you to send claims to the claims address found on your member ID card, or upload in their online portal (if available), or fax it to their claims fax line).

  4. Be sure to make copies of all your paperwork.

  5. Claims must be submitted within 365 days of the date you received the service.

  6. Allow approximately 4 weeks for a reimbursement decision.

What is Psychotherapy like?

Psychotherapy (sometimes called talk therapy) provides a safe and confidential space for individuals to discuss their thoughts and feelings with a trusted professional. It is a process that involves talking to a therapist who is trained to listen and provide guidance.

The client is the expert in their own life. The therapist's role is to facilitate the client's natural process of change. Therapists do this by helping individuals gain insight into their emotions and behaviors, and to provide support and feedback.

In therapy, individuals can expect to receive honest and direct feedback from their therapist, even if it may be difficult to hear. This feedback is intended to help individuals grow and make positive changes in their lives. Unlike talking to a friend, therapy is a structured and intentional process that is designed to help individuals achieve specific goals. It is a collaborative effort between the therapist and the individual, and requires active participation and commitment.

Therapeutic Relationship:

The relationship between therapist and client is the instrument through which client change takes place. As such, close emotional bonds often develop and appropriate professional relationship boundaries must be maintained. Generally, the therapeutic relationship begins and ends in the therapy office.

Although this is sometimes difficult to understand, the ACA Code of Ethics emphasizes the importance of maintaining professional boundaries in the counselor-client relationship for maintenance of the therapeutic environment.

As such, your therapist cannot be expected to be involved in a social relationship or friendship of any kind that exists outside of the therapy office. Also, DFWLPC LLC therapists value your right to privacy and pledge to only acknowledge you in public if you first approach the therapist.

Right to Withdraw from Treatment

If a conflict arises for you or your therapist, either has the right to withdraw from the treatment process. If your therapist feels the need to withdraw from providing treatment, he/she will inform you and provide appropriate referrals.

Click here to visit the "how-it-works" page for more info!

Note: Communication outside of sessions is limited to administrative matters.

What is Teletherapy?

Teletherapy (sometimes called virtual or online therapy) means that the session between the client and therapist will be held remotely instead of in-person.

•        Teletherapy does not provide emergency services. If you are experiencing an emergency, call 911 or proceed to the nearest hospital emergency room for help or contact your physician/psychiatrist. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at: 1-800-273-8255.

•        It is the responsibility of the client to provide their own equipment in order to conduct the teletherapy session. This includes a device such as a phone, computer, or tablet with a functioning camera and Internet access to participate in the session. It is the therapist’s responsibility to provide similar equipment in their environment.

•        It is the responsibility of the client to make sure the environment chosen to participate in the teletherapy session is as private as possible. In this environment, it is the client’s responsibility to keep distractions to a minimum. In addition, it is the responsibility of the client to protect confidential information within their own environment (prevent anyone from listening in to the session from someone else in the home). It is the therapist’s responsibility to do the same in his/her environment.

•        Teletherapy should not be confused with face-to-face therapy because it has the following risks: it is possible for a 3rd party within your environment to overhear the conversations being conducted. In addition, a 3rd party could hack (man in the middle attack) and overhear or see the session as it is being conducted. Any documents or text messages could be obtained by a 3rd party. Viruses, Trojans, Worms, and other programs could reside on client’s computer which could send private information to a 3rd party. Due to these risks, it is important to maintain appropriate security measures. Firewalls, up to date virus scanners, and patched computer systems will help reduce the likelihood of a data breach, however no method is 100% secure.

By scheduling an appointment, you, the client, acknowledge these risks.

Note: Communication outside of sessions is limited to administrative matters.

Session Length: How long are sessions?

Sessions begin promptly and end at the scheduled time. If you arrive late, which happens sometimes, please note that the session will not be extended beyond the regularly scheduled time.

Initial Session: 60 minutes where we get to know one another and discuss your desired outcome.

Normal Counseling Sessions: Vary based on the needs of the client at the time but can range from 15 - 60 minutes or more if needed.

Note: Communication outside of sessions is limited to administrative matters.

Session Quantity: How long will I need therapy?

Regular psychotherapy promotes faster healing and progress, so it is important that you attend your scheduled therapy session consistently.

DURATION:

The duration of Psychotherapy is determined by the you the client's needs. The total number of sessions is dependent on several factors such as your goals, time-frame, and rate of progress for example. Psychotherapy resulting in lasting change can be a long-term process lasting several weeks or several years. However, the client is in control of their progress and it is up to them how long they wish to work with their therapist.

FREQUENCY:

The frequency of sessions may depend on various factors, such as the therapeutic approach, context, costs, approaching the end of therapy, and the need for ongoing support.

Please discuss any issues/concerns you have with your therapist so that an appropriate treatment plan can be formulated which will best suit your needs/desires.

Note: Communication outside of sessions is limited to administrative matters.

Will I have homework?

Possibly! Homework may be assigned. The nature and type of the homework will vary depending on the goals that have been established. It is ultimately the responsibility of the individual to complete it and It is important to keep in mind that the effort you put into the process will determine the outcome.

Risks of Counseling

While positive benefits are expected from counseling services, specific results are not guaranteed. Psychotherapy work involves personal exploration and may lead to major changes in your perspective and life decisions. Some of these changes could be temporarily distressing. However, your therapist is a trained professional and will work with you through the changes to help you realize the best possible results.

Risks may include:

• Deterioration in emotional and psychological stability at different times during the therapeutic process. This often occurs during the beginning stages of therapy, but may occur at any point, often brought on by an awareness of previously unconscious, emotionally loaded material.  

• Therapeutic change may cause varying degrees of tension in significant relationships. This is most often within family relationships but may extend into social and professional life. Long-lasting psychological change often requires a significant investment of time, often longer than a client’s initial estimate.

• If you choose to utilize your insurance, it may affect your insurability. Remember that insurance will need DFWLPC LLC to provide certain information about you including (but may not be limited to) diagnosis, treatment plan, type and dates of service. You will be authorizing us to provide your insurance carrier (or their intermediary) with whatever information is necessary to process your claim. If at any time you have questions about the fees or insurance, please feel free to discuss them with us.

Does DFWLPC LLC counselors just sit and listen?

No! Our skilled therapists go beyond just listening to their clients. The therapist's objective is to help clients gain a deeper understanding of what drives or influences their thoughts and actions, which requires real conversation and collaboration.

Do I have the Right to withdraw from treatment?

You, the client, are in control of your progress and it is up to you how long you wish to work with your therapist. Sometimes life happens and if a conflict arises for you or your therapist, either has the right to withdraw from the treatment process. If your therapist feels the need to withdraw from providing treatment, They will inform you and provide appropriate referrals so you can continue your journey.

What is a documentation fee?

The $50 administrative document processing fee includes the cost to prepare and deliver your documents. Please allow up to 15 business days for processing time after receiving your request and payment.

Please note: Health care providers cannot deny you access to your record because they think the information in the record might upset you. However, they can deny your request if they believe the information would cause physical, mental, or emotional harm to your health.

If you are denied access to your information, you have the right to ask that the denial decision be reviewed. If such a review is required by law, the Custodian of Records will review your request and therapist’s denial. 

What is DFWLPC LLC's Notice of Privacy Practices (HIPAA/TX)?

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

EFFECTIVE DATE OF THIS NOTICE This notice went into effect on 6/1/2023

Federal (HIPAA) and Texas state law requires that information provided to mental health practitioners remain confidential, and we make every effort to ensure confidentiality is maintained with respect to all aspects of your treatment. Please be aware that there are limitations and exceptions to confidentiality, in which case information may be disclosed to the appropriate authorities/agencies/individuals.

For example:

• If your therapist has reason to believe that you are in imminent harm to yourself or others. (This may include appropriate measures to prevent self-harm and/or request for emergency assistance or transportation to the appropriate facility.)

• If your therapist has reason to believe that you are involved in or have knowledge of abuse or neglect of a child, elderly, or disabled person.

• Ordered disclosure by state or federal courts.

Additionally, we will release information with your signed consent in the following circumstances:

• Granting permission to designated third parties to receive information (as needed).

• Discussion of the case with your therapist’s clinical supervisor (if applicable).

Confidentiality With Regard to Minors:

The parents or legal guardians of clients under the age of 18 have the right to access their child’s psychological records. The exception to this is in the case of an emancipated minor. A minor is emancipated if he or she is on active duty with the armed services, is married, or is 16 years of age or older and resides separate and apart from his/her parents, managing conservator, or guardian and manages his/her own financial affairs. Your child’s therapist will discuss with you the limitations, procedures, and implications regarding your child’s records and progress.

I. OUR PLEDGE REGARDING HEALTH INFORMATION: We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. We keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

a. For my use in treating you.

b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

c. For my use in defending ourselves in legal proceedings instituted by you.

d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.

e. Required by law and the use or disclosure is limited to the requirements of such law.

f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

g. Required by a coroner who is performing duties authorized by law.

h. Required to help avert a serious threat to the health and safety of others.

2. Marketing Purposes. As psychotherapists, we will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. As psychotherapists, we will not sell your PHI in the regular course of business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.

10. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we charge a reasonable, cost based fee for doing so. You must submit a written request and a copy of your driver’s license to inspect and/or copy your information. Please note: We may say “no” if we believe the information would cause physical, mental, or emotional harm to your health.

5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request. To obtain this list, you must submit your request in writing to us. It must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper, electronically).

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request. In addition, we may deny your request if you ask to amend information that:

a) We did not create, unless the person or entity that created the information is no longer available to make the amendment

b) Is not part of the information that we keep

c) You would not be permitted to inspect and copy

d) Is accurate and complete

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

How to Use Your Rights Under This Policy

If you wish to communicate with us about privacy issues or if you believe your privacy rights have been violated and wish to file a complaint with our office, you can do so by writing to:

Attn: Custodian of Records

Subject: "Privacy violation"

Address: DFWLPC LLC 500 NORTH CENTRAL EXPRESSWAY, STE 500, PLANO, TX 75074

or INFO@DFWLPC.COM

You will not be penalized for filing a complaint.

Complaints and communications to the Federal Government

If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government. You may write to:

Office for Civil Rights US Department of Health & Human Services

150 S. Independence Mall West

Suite 372, Public Ledger Building

Philadelphia, PA 19106-9111

Email: ocrcomplaint@hhs.gov

You will not be penalized for filing a complaint with the federal government.

Acknowledgement of Receipt of Privacy Notice Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By becoming our client, you will receive and acknowledge that you have received a copy of this Notice of Privacy Practices.

How would clients submit Grievance / Complaints?

You have the right to file a confidential grievance if you have an unresolved concern regarding your counseling services, or any issue involving any representative of DFWLPC LLC.

Any grievance should be in written form and addressed to:

Attn: Owner

Subject: ("Grievance" or "Complaint")

Deliver to:

500 NORTH CENTRAL EXPRESSWAY, STE 500, PLANO, TX 75074

or

INFO@DFWLPC.COM

For complaints involving post-graduate and licensed therapists, you may also contact the appropriate licensing board listed below:

• Texas State Board of Examiners of Professional Counselors (512) 834-6658; 1100 West 49th Street, Austin, TX 78756

• Texas State Board of Examiners of Marriage & Family Therapists (512) 834-6657; 1100 West 49th Street, Austin, TX 78756

• Texas State Board of Examiners of Psychologists (512) 305-7700; 333 Guadalupe, Ste. 2-450, Austin, TX 78701

Can I use FMLA leave for appointments with a therapist?

Yes, according to the Department Of Labor. Assuming that you work for a covered employer and are eligible for The Family and Medical Leave Act (FMLA) leave, you may take leave for treatment visits and mental health therapy sessions for the condition.

What are 5 reasons why clients might choose out-of-network therapist?

  1. You want a therapist who is specialized and experienced. Your relationship with your therapist is one of the most important aspects of the healing process!

  2. Mental Health is often covered differently by insurance companies compared to physical health and other medical services. Your out-of-network benefits to see a therapist may be comparable to or even more affordable than your in-network benefits. Check your health plan’s coverage, you might be able to receive reimburse up to 80 or 90% of each session. Always contact your insurance company before scheduling a session to verify your benefits!

  3. You want personalized services. Therapists can spend more time on an optimized treatment plan just for you when not constrained by insurance contracts, rules, and guidelines.

  4. You don’t want to wait. A 2019 NAMI report found that a mental health visit is over five times more likely to be out-of-network than a primary care appointment. Those few therapists that do participate as in-network tend to be full and have long waiting lists. Out-of-network (private pay) therapists tend to have greater flexibility in scheduling new clients.

  5. You want private and discreet. If you choose to utilize your insurance, it may affect your insurability. In-network therapists are required to provide insurance companies with detailed information regarding your sessions, including a diagnostic code and other highly private material. They need your information for several reasons such as preventing insurance fraud. Private pay sessions are not submitted to insurance and are much more discreet.

What are 3 reasons why therapists might choose not to accept Insurance?

  1. Working with Insurance Companies - Insurance companies provide therapists with client referrals and offer clients potentially more affordable medical services. However, each insurance company has their own rules, pay structure, documentation requirements, restrictions on patient care, quotas, and claims process. Insurers often require therapists to provide ongoing extensive documentation (including client treatment plan and progress) to justify continued treatment and protect against insurance fraud.

    If you are in crisis and need several sessions a week to stabilize, or if you want to continue in therapy for an extended period, an in-network therapist may have to tell you that they are only able to see you once a week for a maximum of eight sessions. Therapists must operate within the constraints outlined by insurance company contract terms in how they provide care to clients.

  2. Supply and Demand - Over a third of the population, nearly 150 million people in the U.S. live in a mental health practitioner shortage area, according to the U.S. Health Resources and Services Administration. This puts the unfair responsibility on in-network therapists to sacrifice income to try and prioritize clients with the most need.

  3. Low Reimbursement Rates – An in-network therapist may bill an insurance company for a session and only receive payment for half or even less. One might assume that insurance companies reimburse therapists for the difference, but this is not true. Additionally, insurance claim reimbursements can take months before the therapist is paid. Collectively, this often results in high burn-out and lower quality of care because therapists are forced to see too many clients to make a livable wage after paying for expenses.

    Typical expenses for therapists to operate include student loans, leasing office space, insurance, practice software, compliance (i.e. HIPAA), advertising, annual continuing education units (CEU), licensure, and more.

How do I get an insurance benefits quote for out-of-network mental health services?

For a free (VOB) Verification Of Benefits just call the number on your insurance card and ask "what is my coverage and cost for a mental health session for both in-person and virtual".