Fees, Insurance
& Policies.

Session rates.

Out-of-network coverage.

Our Insurance Guidelines

Dr. Claney is not contracted with any insurance company. Clients are expected to pay for each appointment up front either “out-of-pocket” or in the hopes of receiving partial “out-of-network” reimbursement. At your request, she will provide you with a detailed receipt (i.e., superbill) each month, which can be submitted to your insurance company for potential out-of-network reimbursement. Out-of-network benefits vary by insurance plan and provider, and reimbursement may be dependent on diagnosis. Please check with your insurance company to see what reimbursement they offer for out-of-network services. Typically, insurance companies will cover 40–80% of the fee, after the deductible is met. Any information they need to know about Dr. Claney or her practice should be available on this form.

Why Dr. Claney is not on insurance panels:

There are many reasons why Dr. Claney is not on insurance panels. As insurance companies are not mental health care professionals, she prefers that they are not involved in the treatment planning, record review, or evaluation of services. These are some factors she has considered and encourages you to consider as well:

• Insurance companies require a diagnosis to be sent in for reimbursement, even for the first session. Your diagnosis and treatment become a part of your permanent medical record. If you are seeking couples therapy, one partner is required to be the designated “patient” and this partner is required to have a diagnosis that necessitates treatment for the couple.
• It is common practice for insurance companies to ask for additional clinical information after the therapy has begun. This may include personal information, treatment plans, or session notes.
• Insurance companies have the power to restrict treatment by limiting frequency of sessions or requiring a specific treatment method.
• Insurance companies determine the provider’s reimbursement rate and rates are inconsistent between companies and market value.
• Communicating with insurance companies requires additional time and negotiation which can be costly for sole providers and oftentimes require a separate billing team.

The benefits of not billing insurance:

• You are not required to have a diagnosis. If you are given a diagnosis, this remains confidential.
• Dr. Claney won’t be required to share any personal or treatment information with an insurance company, thus, you may enjoy a greater degree of privacy.
• An insurance company will not dictate your treatment. Instead, she will use her clinical training to recommend a treatment plan that you’ll develop together. Additionally, she won’t be restricted by frequency of sessions or length of treatment.
• The fee will not be predetermined by another party, allowing for an open discussion of your experience of this investment. This also gives Dr. Claney the flexibility to reserve a portion of the caseload for reduced rates, especially for current clients who undergo financial hardship.
• Her time is not spent communicating with insurance companies, working extraneously to get reimbursed, or negotiating professional value and compensation. Since you pay weekly, you avoid accruing a bill that you cannot afford to pay. Additionally, the therapeutic relationship is protected from possible tension from exchanging services without compensation.

Should you use your insurance for therapy?

Dr. Claney believes this is an important question that is not usually given the weight it deserves. Mental health coverage is included in most insurance plans and can be used to pay for a portion of the therapy (there is typically a copay that the patient is still responsible for). However, the factors indicated above are important for each individual client to consider before seeking reimbursement. For some, the substantial benefit of reimbursement outweighs the loss of independence of insurance involvement. Some clients would prefer the independence from insurance but require the reimbursement in order to access the needed treatment. Some clients prefer to submit claims to help with their yearly deductible and then desist. For others, keeping the work as private as possible is the most important factor. Whatever your circumstance, it is a decision worth thinking through. Please feel free to bring this up if you would like to talk about it in more detail.

One more note: It is common for mental health claims to be initially denied. This can be discouraging; however, you do have the right to appeal this denial. Insurance companies may count on consumers to give up once a claim is denied, so it is to your benefit to appeal a claim that should or could be paid. Companies like Reimbursify or Mentaya can help with re-submitting a denied claim.

Will your health insurance cover testing?

Most health insurance policies do cover testing if they consider testing to be “medically indicated” or “medically necessary.” This means that the problems you have that require testing are either the result of a medical issue or there is a psychiatric diagnostic issue that cannot be resolved just by interviewing the person. Most insurance companies do not cover testing for educational purposes (as opposed to medical or psychiatric purposes). An educational purpose includes testing for learning disabilities or the necessity of accommodations for high-stakes testing like the bar exam or GMAT. If there is a medical or psychiatric issue which the testing will address, the insurance company may provide full or partial coverage.

These are the steps you should follow to find out whether your insurance company will help pay for the testing:

1. Call your insurance company and ask whether you are covered for the CPT codes listed on this form. When you call, be sure to specify the reason for the testing (e.g., ADHD, autism, learning disability, diagnostic, therapeutic) and be sure to ask explicitly whether testing is covered for that reason. Make sure you understand what is and is not covered and why that is the case for your particular plan.
2. If you are told that testing is covered, ask if you will need “precertification” or “preauthorization” (i.e., advance approval) and clarify if there is “out-of-network” coverage. Ask what preauthorization means for an out-of-network provider who will not be doing any insurance authorization on your behalf. Ask them to be very specific and possibly send you the documentation you need to complete prior to the evaluation while you are on the phone with them. Any information they need to know about Relational Psych should be available on this form.
3. Request specific instructions on how to submit the out-of-network claim, documenting each step of the way on who you spoke with and what was said. Keep in mind that you may receive incorrect information over the telephone and the final determination is made only when the claim is submitted.

Sliding scale availability.

Dr. Claney reserves a portion of her caseload for clients with reduced rates (such as students or current clients undergoing financial hardship). Please inquire regarding availability with an idea of what fee would be feasible for you.

She believes that psychological services are an investment in yourself, and that investment comes at real cost, financial and emotional. Please share any concerns about the fee directly with her, as this may be an ongoing discussion throughout the work.

Your right to a Good Faith Estimate.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Practice policies.