Insurance Benefits

You are fully responsible for obtaining and understanding your own plan's mental health benefits - we do not provide courtesy insurance benefits checks. Note the mental or behavioral health benefits are specific to each plan and copays may be different from your medical copays.  Usually, your insurance card will have the member information number, which you can call to ask questions and understand your benefits.

Do I have in-network mental/behavioral health benefits?

• If the answer is yes, you can see any provider in-network with your plan (e.g., if you have Aetna, you can see a provider who takes Aetna).
• In-network is more affordable than out-of-network. This is because in-network providers have agreed to accept a discounted rate for services in exchange for being part of the insurance company’s network

   

What is my in-network deductible? 

Has any amount of my deductible been covered this year?

What is my copay amount? 

• You are usually responsible for paying a deductible for in-network services (usually $100 and $3500 per year), and after that is met, you are responsible for covering only the copays (usually $10 and $75 per session). The therapists will be reimbursed the remaining balance directly by the insurance company.

   

Do I have out-of-network mental/behavioral health benefits?

• With out-of-network benefits, you will pay more, but you can choose any King Health Associates therapist you’d like to see who has openings and your insurance company will reimburse you for the costs. 
• A plan that includes out-of-network benefits is usually referred to as Preferred Provider Organization Plan (PPO) or Point-Of-Service Plan (POS).

Do I have an out-of-network deductible that has to be met first before I get reimbursed? Has any amount of my deductible been covered this year?  

• Out-of-network deductibles can range from $100 and $10,000 per year.
• If any amount of your deductible has been met, you will only be responsible for meeting the remaining amount. For example, if your out-of-network deductible is $3,000 and you have already seen an out-of-network provider for $1,000 of services, you will only need to pay for $2,000 of therapy sessions before receiving reimbursement.
   

What is my co-insurance amount? 

• Co-insurance typically ranges between 20-40% of the session cost. Co-insurance is the amount that you pay out of pocket - without reimbursement - per service after your deductible has been met. 
• For example, if the session cost is $200, you will be reimbursed between $120 and $160 per session by your insurance company.
   

What is the usual and customary rate covered by my insurance for outpatient psychotherapy (CPT code 90837)? 

• Insurance companies unfortunately do not reimburse the full amount of your therapist fee. They will cover a percentage amount of what they deem is acceptable for a therapy session - this is often referred to as “customary rate” or “allowable amount”. Each plan in each insurance company “allows” a different amount. 
• **PREMERA PLANS Associates cannot see

  • LIT, STJ, EGN

    PSC - Catholic/Christian School Employees

    TMP - Teamsters

    Any Boeing or BCBS of Illinois

    Beacon Health/Value

    PBH or PBQ Providence through BCBS (mental health is carved out to Optum) 

    Federal Employee Program says FEP on card, always starts with prefix R, may process though Premera or BCBS in other states but processes though Regence only in WA

    Use this link to determine your plan's' prefix https://www.bcbs.com/member-services