Payment & Insurance

We know navigating health coverage can be stressful, so we try to make it as stress-free as possible.

The big question

How much does a session cost?

Your session cost will vary depending on the type of service. Also, the cost varies if you decide to use insurance and how much your insurance will cover. The initial visit includes a first-time administration start-up fee. Our Intake Coordinator is trained to listen and match you with the therapist qualified to fit your needs and will provide detailed payment information on the phone when you reach out for your specific therapist match. Providing your insurance details in our secure contact form allows our office to check your insurance benefits prior to calling you back, so we can communicate financial information clearly. You can also leave a message for general details at 312-772-9796, extension 0.

Insurance Coverage

In-Network Insurance Coverage

We are currently in-network with BCBS PPO plans and will bill your insurance for you under these plans. Coverage varies widely between insurance plans. It is important to note that PPO plans are different than HMO plans from BCBS, and we are not in-network with HMO insurance plans. However, with a referral from your PCP you may be able to advocate for a 50% reimbursement for sessions under BCBS HMO plans, depending on your plan. Proceed to the below section to understand how HMO out-of-network benefits are processed.

Out-Of-Network Insurance Coverage

All other insurance plans can utilize the out-of-network benefits available to them. With out-of-network we collect the full fee for session at the time of the appointment and give you a receipt with everything you need to file a potential reimbursement claim with your insurance. We can work together to understand your coverage and get you the help you need. Our office recommends calling your insurance company and asking specifically about out-of-network benefits.

More questions about insurance? We’ve got answers…

What if my insurance does not cover my sessions?

There are cases where some insurance companies will not cover your mental health needs. If your insurance is in this category, you have a couple of choices. You may decide to pay for your sessions out-of-pocket, or you may decide to reduce the frequency of your visits or participate in group counseling. All of these options may impact the financials for receiving support. Please bring up financial concerns with your therapist so you can make a plan together.

How do I verify Out-Of-Network insurance benefits guide

Have your insurance card nearby. Speak to a customer service representative, as the automated benefits line does not always include Behavioral Health benefits.  

Verifying Benefits 

“I need my benefits for Outpatient Mental Health with in-network and out-of-network providers.” Please Note: Optimum Joy, P.C. is considered an Out of Network Provider of Mental Health Care. 

“What are my out-of-network mental health benefits?”

“What are my effective dates of coverage?”

“What is my annual deductible and how much has been met to date?”

“What is the different rates of reimbursement for the following CPT codes:”

90791: Psychiatric Diagnostic Evaluation

90837: Psychotherapy, 60 min

90834: Psychotherapy, 45 min

90847: Family psychotherapy, conjoint psychotherapy with patient present

“Where do we mail Behavioral Health claims?”

“Is precertification required?” If so, transfer to Authorizations Department and follow guidelines in next section. 

Obtaining Authorization/Precertification 

Know your therapist’s name and credentials and mailing address.

“What is the authorization start date and end date (Be sure to disclose your first session date, if you know it, so it will be included in authorization.)

“How many sessions are authorized?”

“Where do we mail claims?” (IMPORTANT: This is often a different address than the one used in cases where precertification is NOT required).

Do you contract with insurance companies?

We are committed to you & your family’s privacy, their confidentiality, and want you to have complete control over their health records. Submitting a mental health invoice for reimbursement carries a certain amount of risk to your confidentiality, privacy and future capacity to obtain health or life insurance or even a job. That is why we caution people to consider their risk to privacy prior to billing insurance for mental health services.

We are in-network with BCBS PPO insurance plans and our office bills these plans directly to the insurance. You would simply be responsible for any co-pay or unpaid services.

We can also provide you with receipts and a coded visit bill which you may submit to your insurance company for out-of-network reimbursement if you choose. We encourage you to check with your insurance regarding the specifics of your policy. If you want more information on this, don’t hesitate to contact our intake coordinator.

If you’d like to know your insurance coverage, call us today!

What are the benefits and risks of using insurance

The use of insurance can be a helpful way to help cover the costs of therapy. In some situations insurance coverage might be the only way you or a member of your family can afford the care needed.

There are, however, some considerations you may want to keep in mind in deciding whether or not to use insurance. The most obvious concern is privacy, especially in situations where benefits may be administered through your employer’s human resource department or a managed care company. Many managed care programs require additional information beyond a diagnosis and sessions dates, such as treatment summaries and goal statements to determine eligibility for ongoing benefits. Optimum Joy is committed to preserving your privacy according to the Health Insurance Portability and Accountability Act (HIPAA) and to providing insurance companies only what is required to attain coverage. Unfortunately, we can not make assurances about what happens to information after it leaves our office. Further, use of insurance of any sort creates a record that might come into play later on when completing applications for life, health or disability insurance. People have been denied insurance and in some circumstances jobs because of preexisting mental health diagnosis.

There are also situations where the insurance benefit for mental health may be quite limited or situations where a deductible may be quite large. In such situations you may need to weigh the expected benefit against the cost of sessions anticipated.

We can not advise you regarding your decision to use insurance but feel an informed decision is the best pathway to a good decision.

Pricing

Individual – $180 Startup Session, $155 per Session 

Couples Work – $195 Startup Session,  $175 per Session

Family + Relationship Work – $195 Startup Session, $175 per Session

Clinical Resident – Reduced Fee Available 

We can help you get started