- Individual Initial Assessment, 45-55 minutes: $250
- Individual Psychotherapy session, 45-55 minutes: $250
- Training and Consulting: Contact Joy Carter, LCSW for more information
Joy Carter, LCSW does not accept insurance to ensure increased privacy and enhanced quality of care. However, you are welcomed to use FSA/HSA funds via debit/credit card or use your insurance’s out-of-network benefit to submit your own claims if it is offered.
Checking Out-of-Network benefits with your insurance
Use this link to access a handout to help you check if you have Out-of-Network (OON) benefits with your insurance. It also includes questions to ask your insurance company to determine your coverage if you do have OON benefits. Typically PPO plans have OON benefits while HMO plans do not. Joy Carter, LCSW does not file any claims with insurance, including OON benefit claims. However, I am happy to provide you with a superbill to submit to your insurance with your claim. Please note, that when you use your insurance’s OON benefits, the insurance company requires a diagnosis in order to process your claim. The insurance company can also request access your clinical information in the event of an audit or if they need further information to process your claim.
Advantages of not using insurance to pay for therapy include enhanced quality of care and other advantages, such as:
- You are in control of your care, including choosing your therapist, length of treatment, etc.
- Increased privacy and confidentiality (except for limits of confidentiality).
- Not having a mental health disorder diagnosis on your medical record.
- Consulting with me on non-psychiatric issues that are important to you that aren’t billable by insurance, such as learning how to cope with life changes, gaining more effective communication techniques for your relationships, increasing personal insight, and developing healthy new skills.
Disadvantages of using insurance to pay for therapy include:
Reduced Ability to Choose
Most health care plans today (insurance, PPO, HMO, etc.) offer little coverage and/or reimbursement for mental health services. Most HMOs and PPOs require “preauthorization” before you can receive services. This means you must call the company and justify why you are seeking therapeutic services in order for you to receive reimbursement. The insurance representative, who may or may not be a mental health professional, will decide whether services will be allowed. If authorization is given, you are often restricted to seeing the providers on the insurance company’s list. Reimbursement is reduced if you choose someone who is not on the contracted list; consequently, your choice of providers is often significantly restricted.
Pre-Authorization and Reduced Confidentiality
Insurance typically authorizes several therapy sessions at a time. When these sessions are finished, your therapist must justify the need for continued services. Sometimes additional sessions are not authorized, leading to an end of the therapeutic relationship even if therapeutic goals are not completely met. Your insurance company may require additional clinical information that is confidential in order to approve or justify a continuation of services. Confidentiality cannot be assured or guaranteed when an insurance company requires information to approve continued services. Even if the therapist justifies the need for ongoing services, your insurance company may decline services. Your insurance company dictates if treatment will or will not be covered. In addition, if you use Out of Network benefits through your insurance, they require a diagnosis and may request access to your personal clinical information in the event of an audit. Note: Personal information might be added to national medical information data banks regarding treatment.
Negative Impacts of a Psychiatric Diagnosis
Insurance companies require clinicians to give a mental health diagnosis (i.e., “major depression” or “obsessive-compulsive disorder”) for reimbursement. Psychiatric diagnoses may negatively impact you in the following ways:
- Denial of insurance when applying for disability or life insurance.
- Company (mis)control of information when claims are processed.
- Loss of confidentiality due to the increased number of persons handling claims;
- Loss of employment and/or repercussions of a diagnosis in situations where you may be required to reveal a mental health disorder diagnosis on your record. This includes but is not limited to: applying for a job, financial aid, and/or concealed weapons permits.
- A psychiatric diagnosis can be brought into a court case (ie: divorce court, family law, criminal, etc.).
- Some psychiatric diagnoses are not eligible for reimbursement. This is often true for marriage/couples therapy.