Understanding Payments and Fees
What are my options?
Navigating the mental health system is complicated. One of the major barriers is financial access to services. Listed below are the several different options to afford necessary services:
Medical Insurance
Out - of - Network Benefits
Private Pay
Employee Assistance Programs/ Work Funded Benefits
Medical Insurance
Most people already pay a premium to have health insurance and thus want to use it towards their medical expenses. Marisa has paneled and networked herself with multiple insurance companies to reach those who are trying to find affordable means to access necessary treatment. Please note, Marisa has already pre-negotiated rates with each insurance plan and therefore she cannot make any changes in cost of service nor adjust any client’s premiums, copays or deductibles. Individuals who choose to use insurance are subject to their own agreed benefits and Marisa will submit necessary documentation to support a covered service.
Insurances in Network
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Most traditional Cigna Plans are accepted, (ex. PPOs, HMOs, etc.)
Trustmark Health Benefits - Cigna
Allegiance
Daniel H. Cook Administrators
Professional Benefit Administrators
S&S Healthcare Strategies
Tall Tree Administrators
Trustmark
Wellfleet Group, LLC
Southwest Service Administrators
Paragon Benefits
The following plans are NOT in network:
Flume Health
Florida Health Administrators
Gilsbar TPA
Healthpartners Inc.
Magnolia Health
Priority Health
UPMC Healthplan
medicaid & medicare plans
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Most traditional Aetna plans ( ex. PPOs, HMOs, etc.)
Meritain
Nippon
Allied Benefit Systems
GEHA - United Healthcare Shared Services (UHSS)
Trustmark
Trustmark Small Business Benefits
Health Scope
Christian Brothers Services
Insurances that are NOT included
GEHA - Aetna**
Boon Chapman
AmeriBen
Health First
Piedmont/S&S Healthcare
Health Smart
Emi Health
WebTPA
Aetna Medicare and Medicaid plans
** GEHA - Aetna is not currently accepted UNLESS the plan includes mental health benefits managed by United Healthcare Shared Services.
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UnitedHealthcare
UnitedHealthcare Shared Services (UHSS)
GEHA - UnitedHealthcare Shared Services (UHSS)
UnitedHealthcare Global
UnitedHealthCare Exchange Plans (ONEX)
Oscar
Oxford
UHC Student Resources
UMR
All Savers (UHC)
Health Plans Inc
Surest (Formerly Bind)
Insurances NOT in network:
Select Health
Health Plans of Nevada
Cenpatico
Sierra Health and Life Health Plans
Arizona Complete Health
Optum Medicare and Medicaid plans
Please Note: Marisa is NOT in network with any Medicaid or Medicare plans.
Don’t see your insurance carrier? Check below for Marisa’s fee schedule to see if private pay is an option
Things to Consider When Using Medical Insurance
Benefits
Getting to utilize your health benefits in which you already pay premiums for
Cost sharing of services that help lessen the financial burden
The ease of claims being submitted on your behalf with minimal need to coordinate or advocate with your insurance plan regarding payment of services
Shortcomings
Medical insurance REQUIRES diagnoses and medical codes in order to be covered. Having conditions attached to your record can influence future health, life and disability benefits and premiums
Medical insurance dictates specific types of therapeutic modalities used and therefore can limit access to specific types of treatment that they do not believe to be helpful
Certain plans have limits regarding length of time/amount of sessions they are willing to cover pending the diagnostic code. This can impact ability for services to be covered ongoing
Out of Network Benefits
Many insurance plans provide “out of network benefits”, where a provider will charge the client their service fee rate and the client will be able to provide a superbill to their insurance to receive reimbursement. Client’s are expected to pay their full bill at time of service and are responsible for submitting their claims directly to their insurance. Each insurance plan varies based on reimbursement rate but for many people, insurances will reimburse up to 80% of costs spent.
Shortcomings
You will need to submit reimbursement claims on your own and be able to upfront initial cost at time of service
Since you are still utilizing medical insurance, you are subject to following their agreed treatment modalities, timelines and medical coding/diagnostic standards
EAP & Work Benefits
Your employer may have options that provide covered mental health care services as a benefit of your company. These are prepaid sessions that your employer will cover on your behalf if requested. Contact your Human resources Department to see if EAP benefits can be awarded.
Shortcomings
Session variation are typically limited and there is a pre-set number of sessions to address mental health concerns
Some employers require releases of information (ROIs) to be signed in order for them to be able to discuss treatment plans and support
Private Pay
Private pay is when an individual covers the entirety of their service without requesting reimbursement from any insurance provider (also known as paying out of pocket). Private pay provides the most flexibility and security of your services, as there will be no notification to insurances regarding your medical care. When you use any insurance, providers must provide justification to insurance company for why the service was necessary. This can add restrictions regarding how often an individual can seek services, what types of therapeutic modalities insurance is willing to cover and what types of justification must be provided. At a minimum, insurance providers require a diagnosis to approve services, however they may also request therapy notes, treatment plans and duration of ongoing problems in order to process your claim. Therapists cannot control what or how insurances use this information in the future, as it can become part of your permanent medical record which can impact ability to receive specific life, health and disability premiums or benefits in the future. Private pay allows treatment to be dictated by the therapist and yourself, versus by regulations an insurance carrier prefers. Private pay also encompasses those who are facing financial hardships or who are uninsured and require a sliding fee scale.
Shortcomings
Fee rate could be higher than medical insurance co-pays, deductibles or coinsurance depending on your plan
No Reimbursement
None of your services will go towards your out of pocket medical expenses or limits that could be part of your insurance plan
Marisa’s Fee Schedule
Intake Assessment (First Appointment) | $150
Individual Session | $100
Individual Session with Support Person(s) | $120
Couples/ Family Therapy Session | $120
Group Therapy Session | $10
Crisis Appointment (Individual or family) | $120
Therapy Appointments that go over the allotted time will be billed at a rate of $30 per each half hour extended over designated time
Financial Hardship?
Marisa encourages those experiencing financial hardships to reach out and discuss sliding fee scales and bundled services. Marisa aims to take into account each persons unique circumstances when determining eligibility for reduced fee services. Please note, if you use the sliding fee scale, claims/fees will most likely be denied by your insurance if you are submitting them for reimbursement.
Whether you go through insurance, out-of-network, EAP, or private pay - you are always welcome to use your Health Savings Accounts (HSA) or Flexible Savings Accounts (FSAs) to pay for therapy services.
Just a quick reminder!
If you are currently receiving mental health services that are being coded as a “therapy session”, your insurance may not cover your services with Marisa in addition. Insurances do not process claims that appear to have a “duplicate of service”, meaning two mental health professionals providing the same service. This would mean that one provider will most likely need to be out-of-pocket whereas the other provider can utilize the insurance benefit. If you are concerned that this may apply to you, please contact your insurance company to determine your policy benefits.