This page contains a lot of information — but it is worth the read. We have attempted to answer the most common questions we get about the financial aspect of care.
Because all of our providers are independent, each provider has his/her own policy for working with insurance. Just because your insurance is not listed as in-network does not necessarily mean you cannot use it! Click on a provider’s bio to see what they accept.
The basic rule of thumb is: Every plan is different because rates and coverage are negotiated specifically with your group. The name of the insurance carrier doesn’t tell us what they cover, your specific plan does. It is always wise to call the customer service number on the back of your card to be sure. See the “Talking to Insurance” section below for tips.
State and Federal Insurance
If you are insured by Molina, Washington Apple Health, Medicare, or Medicaid, we regret that we do not have any providers under contract and they require this for coverage. Under the RESOURCES heading please click the Mental Health Links for resources who may be able to help.
Types of Insurance
HMO (Health Management Organization):
- Often called: “Core,” “Basic,” “Bronze,” etc.
- Key feature: Any provider they cover must be in a formal contract with that insurance carrier. Providers must agree to their terms for rates, record-keeping, types of services covered, etc. This is what “in-network” means.
- Consumer cost-share: Consumers will typically have a copay with a fixed dollar amount, and the provider cannot bill you for charges above the rate in their contract.
PPO (Preferred Provider Organization):
- Often called: “Choice,” “Options,” “Gold,” etc.
- Key feature: There is often a symbol on the front of the card with the letters “PPO” inside a little doctor’s bag. Consumers may see any licensed provider they wish, contracted or not.
- Consumer cost-share: Coinsurance may be a bit higher for non-contracted providers, but consumers will still probably get around a 50%-70% coverage. Providers may bill you for charges above maximum allowable rates — so be sure to ask about the provider’s rate so you can calculate an accurate cost.
HSA (Health Savings Account):
- Spending card that typically accompanies high-deductible plans. Most providers here accept HSA.
- Be sure and ask your provider for a statement showing what your payment and services received, as your HSA records may be audited.
Using Insurance at The Shepherd’s Center
We have three types of providers. All providers accept private pay.
In-network/Out-of-network: Contracted with some insurance companies but not others. They will typically bill insurance for you, meaning you have only your copay/coinsurance due at time of service. Accepts HSA.
Out-Of-Network only: These providers may or may not bill for you, and are covered only by PPO plans. Providers who do not bill insurance will provide you with the specific type of receipt you need to seek reimbursement from your insurance company (called a “superbill”). Accepts HSA.
Private-Pay Only: These providers are not eligible for insurance coverage and require full out-of-pocket payment. These include therapists with an associate license or pastoral counselors. Typically accepts HSA.
One great thing about private pay is that (with few legally-mandated exceptions), you get absolute say over who can see your records. Insurance companies and future employers cannot access them without your explicit permission. Contracted (in-network) providers may be required to give your notes to insurance companies in order to review medical necessity or for government audits, but not if you private pay!
Private pay may be the way to go if:
- You don’t want to answer to anyone about why you are in counseling.
- You don’t want to worry about the number of sessions you are allowed (varies widely by plan).
- You are getting counseling for your child and they may someday want to work in a field that requires psychological review (e.g., law enforcement, career military, sensitive tech).
- Counseling isn’t medically necessary but you really need some therapy help right now!
Talking to Insurance
We want you to be in-the-know! Calling member services will help you tell us exactly what you need and eliminate a lot of communication wait time!
Good questions to ask:
1) Do I have out-of-network coverage?
2) What is my deductible? How much do I have left to meet?
3) What is my coinsurance for in-network/out-of-network, outpatient behavioral health services?
4) How many sessions are covered?
4) Do I have coverage for family therapy? [Click here for more information about family therapy coverage] (Link to blog post explaining what’s different between family and individual counseling in terms of records, payment, identified client, goals).
5) Does my plan cover telehealth therapy? (Some providers offer this if therapeutically appropriate.)
We hope this information was helpful to you in navigating the financial piece of your care. If you have further questions, please call us at 253-858-2224 and we will return your call and help as we are able.