Out of Network Insurance Questions
At Love Heal Grow we do not accept third-party payer benefit plans. This includes insurance, EAP, Victim/Witness Assistance Programs, court/law firm payments.
Clients are required to pay Love Heal Grow directly at the time of their session and fees for therapy range 160-450/session depending on the therapist. All fees are listed under their mini bios on each service page and the scheduling page.
Sometimes insurance companies or EAP plans are willing to reimburse their clients for out of network care. You can check with your plan directly to see if they offer this.
If they do, you are still responsible to pay Love Heal Grow 100% of the cost of therapy. Then you would submit for reimbursement to your plan — this would be worked out directly with your plan and we are hands off in this process.
We address the most commonly asked insurance related questions below:
Okay, but do you accept my insurance plan or EAP plan?
Sometimes folks read that we don’t accept insurance or EAP plans, but think their plan may be different. Unfortunately, the answer is still no. We do not accept any third-party insurance or EAP plans.
Contact your plan directly to see if they can reimburse you for fees you pay to us or to get a list of providers who are in-network with your plan.
Do you accept Victim/Witness Assistance Program benefits?
No. Contact your advocate for support or direction in finding a provider if you would like to use your benefits.
Can I use my HSA/FSA card?
Yes. This isn’t a third-party payer—it’s just your money that you set aside pretax. You can use your plan’s debit card for payment.
Why don’t you work with insurance or my benefits?
This is a complex question and we are happy to give you the bullet points.
- Insurance companies profit by denying care, controlling care, and devaluing service providers. This is a sad truth. Insurance companies pay out patient mental health therapists so little that many therapists cannot make a living unless they see so many clients a week that they are at a high risk of burnout, compassion fatigue, or a subpar level of care.
- Insurance companies will not pay for therapy where there isn’t a medical necessity. In most cases couples therapy does not meet medical necessity in the eyes of insurance.
- Insurance companies dictate the use of short-term therapeutic care in most cases. This level of care often puts a band aid on the real and complex struggles that an individual, family, or couple has. This leads to therapy participants feeling dissatisfied with the care they receive, deflated because they can’t make change with the type of therapy they receive, and frustrated by the entire process. We believe high quality therapeutic care involves the therapist and client making decisions together about the therapeutic process without insurance involved.
- Insurance companies have the right to “clawback” money they pay to a therapist for services provided many many months after the service was provided. Even if they already approved the services! This is sometimes thousands of dollars that the client is now required to pay out of pocket with no notice.
- Our therapists are highly specialized. Most highly specialized therapists do not accept insurance because of all the reasons above.
- We want to provide our therapists with a living wage, work/life balance, many opportunities for support and growth within our company, a high standard for training and supervision, health insurance, PTO and sick time, a 401k plan, a clean/safe/beautiful workspace, technology, and other benefits.
- We want to provide our clients with a very high standard of specialized care, happy and skilled therapists, a clean/safe/beautiful office space, and accessible educational information.
How do I seek reimbursement?
1. You must inform your therapist directly that you are seeking reimbursement.
If you do not inform them they will not assess diagnostic criteria that is required to be attached to your account for insurance to provide reimbursement.
2. Check with your plan to see if this is a benefit you have.
Contact your insurance company’s member services and ask the following questions:
- What is my out-of-network deductible for outpatient mental health visits?
- Do out-of-network benefits include mental health practitioners with the following license: LMFT, LCSW, LPCC, AMFT, ACSW, APCC (provide the license of your chosen practitioner).
- How much of my deductible has been met this year?
- What is my out-of-network coinsurance for outpatient mental health visits?
- Do I need a referral from an in-network provider or a primary care physician to see someone out-of-network?
- How do I submit claims for out-of-network reimbursement?
3. A superbill will be auto-populated the first of every month.
Sign onto the client portal to download. All information required by insurance is on your superbill.
4. Follow the requirements of your plan to seek reimbursment.
This may include entering information into their website, completing paperwork, or sending a photo/pdf of the superbill.
5. Contact your therapist directly if there is missing information on your superbill.
We are not able to communicate directly with your insurance company. We are hands off in the reimbursement process.
My insurance company rejected my submission for reimbursement, can you help?
I’m sorry you are experiencing this! Once we provide you the superbill we are hands off and have no control on what your insurance company does. If there is missing information on your superbill, please tell your therapist.
This is one of the many ways insurance companies make a profit – making barriers for you to be able to receive the benefits you pay for. It can be really frustrating!!
Therapists can help you get the following information added to your superbill:
-Your diagnosis
-Therapist NPI number or license number
-Practice NPI number or tax id number
-A W9 for your insurance company
Therapists cannot help you with the following problems:
-Making up a diagnosis so your insurance plan will pay for care (this is fraud)
-Making a single-case agreement with your plan. We do not do this.
-Redesigning our superbill to provide information we don’t typically provide or to have it look exactly like your insurance plan wants it to look.
-Misrepresenting the type of therapy or who was present in therapy (this is fraud)
-Filling out paperwork required by your plan unless they are compensated by you to do so
