|10:00 AM - 8:00 PM
|10:00 AM - 8:00 PM
|10:00 AM - 8:00 PM
|10:00 AM - 8:00 PM
*Early morning appointments are available upon request, if necessary.
$200.00 per Initial 50-minute Diagnostic Evaluation
$150.00 per 50-minute Psychotherapy session
I am a contracted provider for most commercial insurances including:
Blue Cross/Blue Shield (all products including HMO Blue/PPO/Federal/Blue Choice) I DO NOT ACCEPT ANTHEM BC/BS
Harvard Pilgrim Health Care
Optum Behavioral Health
United Behavioral Health
Cigna and Cigna Behavioral Health
Beacon Health Strategies
All One Health EAP
Neighborhood Health Plan
Tufts Health Plan
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by asking the following questions:
- Do I have mental health benefits?
- What is my deductible and has it been met?
- How many sessions per calendar year does my plan cover?
- How much does my plan cover for an out-of-network provider?
- What is the coverage amount per therapy session?
- Is approval required from my primary care physician?
In this age of complicated health insurance plans, most of us don’t fully understand what many of the terms that are used by health insurances regarding our plans, our coverage and what members are financially responsible for.
In an effort to help you to figure all of this out and to help us at Advanced Counseling Therapies to anticipate any further confusion regarding your out of pocket expenses for your therapy sessions, we have provided the following information to make this a little clearer.
HMO? FSA? HDHP? A quick guide to help navigate the complicated terminology of a complicated health care system.
If you don’t know a CDHP from an HSA, you’re not alone. Yet considering that consumers are often on the hook for health care expenses, becoming fluent in health care language is essential. Here’s a quick guide to help you understand health insurance terminology and what it can mean to your wallet.
A consumer-directed health plan generally has a higher deductible, lower monthly premiums, and requires that patients meet their deductible before insurance benefits kick in. As its name implies, patients must be proactive in managing their care by tracking expenses for out-of-network expenses. Employees pay for these expenses through paycheck deductions directed to an HSA. The CDHP is an HDHP paired with an HSA
A high deductible health plan, defined by the Internal Revenue Service as having a minimum deductible of $1,400 for an individual or $2,800 for a family, generally has lower monthly premiums and allows for an HSA. Other than preventive care, it doesn’t cover any services such as prescription medications, emergency department visits, or visits to specialists.
Is the amount you pay each month for insurance. While we think of premiums rising each year, they are actually falling in the individual market for 2020. But that doesn’t mean the cost of the plan you buy is falling. According to the Kaiser Family Foundation, the average cost of a family plan offered by an employer is $20,000, an increase of 22 percent over five years — but employees don’t see this cost because employers pay an average of 70 percent of family coverage.
You might know the word deductible from your car insurance or homeowner’s insurance. In health insurance, a deductible is the amount you have to pay as the patient before the insurance pays anything — and they have been rising. The average deductible of an employer plan is now $1,655, up from 10 years ago by $533. They can be thousands of dollars in the individual market. But most plans cover preventive services before the deductible. And some plans will cover a number of out-patient services, like office visits, before the deductible.
The amount a patient must pay before the health insurer covers health care services. This fee is in addition to monthly premiums. Services, such as preventive care, prenatal care, emergency department visits are usually covered before meeting the deductible, but check with your insurer.
CO-PAY is the fixed dollar amount you pay for a service — say, $30 to go to a doctor.
CO-INSURANCE is the percentage split between what you and insurance pay, perhaps you pay 20 percent for brand name drug and the insurer pays 80 percent. Finally, there is the ever-important, but little known, MOOP (Maximum Out-of-Pocket), which is the most you will ever pay in the plan year for covered services if you go in-network. The MOOP is basically the worst-case scenario — if you have an expensive illness or accident, you know the MOOP protects you. WE DO NOT ACCEPT CO-INSURANCE
It’s important to look at the provider directory to find providers in-network. Even if your plan covers services out-of- network, I I promise it’s not as generous as you think. If the plan says it covers 70 percent of services out of network, it means it covers 70 percent of what the insurer believes is a reasonable rate, which is often well below the actual bill. So you could be left with hundreds or even thousands of dollars of what’s called balance billing — basically, the provider charges you the balance of what the insurer doesn’t pay. So start by going in-network whenever you can.
FLEXIBLE SPENDING ACCOUNT (FSA)
Employees can direct pre-tax dollars from their paychecks to an account that can be used to pay for eligible medical and dental expenses. FSA contribution limits are set by the IRS each year. Typically, money in the FSA must be used within the plan year, otherwise funds get surrendered. Employers can opt for two options: (1) Offer a grace period of two-and-a-half months where expenses incurred in the plan year up to the grace period deadline can be paid through the FSA, or (2) roll up to $500 in unused dollars over to next plan year’s account.
HEALTH SAVINGS ACCOUNT (HSA)
A health savings account is an employee-funded savings plan for eligible medical expenses, sometimes with an employer match or fund component. Employees can direct a set amount from their paychecks into the tax-deductible account. The IRS caps how much employees can contribute per calendar year on an individual and family level. HSAs don’t follow the same “use or lose’’ FSA rule. The money in the HSA belongs to the participant and rolls over from year to year.
GAP OR SUPPLEMENTAL INSURANCE Gap insurance is essentially insurance for insurance. Its benefits are limited to paying for deductibles, copayments, and other out-of-pocket expenses not covered by a patient’s primary health insurance. It cannot be used as primary health insurance.
It is the responsibility of every new client to obtain this information, as well as an authorization for services prior to your first scheduled appointment. It is also
understood that should there be a deductible, payment of the full contracted rate usually covered by your insurance company will be made at the time of each session. WE DO NOT ACCEPT GAP OR SUPPLEMENTAL INSURANCE
Reduced fee services are available on a limited basis.
Insurance co-pays are expected to be paid at the time of session. Cash, check, and credit cards (through PayPal), are accepted. Checks can be made payable to either Michael Oster, LICSW or Advanced Counseling Therapies. If you would like to pay by credit card, go to the Make a Payment page.
If you have an established PayPal account, you can enter your co-pay amount, click enter and you will be brought to the PayPal window. Confirm the payment and submit it. If you would like PayPal to automatically pay your co-pays on a weekly or monthly basis, you may establish an auto-payment through the web site as well. This payment option must also include auto-payments on your no show/cancellation fees. Co-payments through PayPal are expected to be paid promptly and must be received prior to your next scheduled visit . If co-payments are not received by this time, payment by credit card will no longer be an option to you.
If you do not show up for your scheduled appointment and have not notified us at least 24 hours in advance, you will be required to pay $100.00 out of pocket. However, if you are able to fill in another canceled appointment time during the same week, that fee will be waived, provided an opening is available.
Request an appointment online here .
Questions? Please contact me for further information.