Insurance vs. Private Pay

Insurance & Fees:

  • Sessions are 40-45 minutes.

  • The M.A.D. Therapy does take a limited number of insurance plans. Payment, co-pays and/or co-insurance and deductible are expected at the time of service and/or when specified by insurance companies.

  • Payment forms: cash, check, credit card or HSA accepted as payment.  

  • Please check with your insurance for Out-of-Network benefits. At your request you may be provided with a Superbill to submit to your insurance for possible reimbursement.

  • Reduced fee services are available on a limited basis. 

  • Cancellation Policy: Requires a 24 hour notice to cancel. There will be a $60 charge for less than a 24 hour notice. The full session fee is charged if you do not show for your reserved appointment.

Accepted Insurance Plans:

  • Blue Cross Blue Shield

  • Straight United HealthCare (not UHC of the River Valley)

  • UMR

Frequently Asked Questions

Do you take insurance? How does that work?
Yes. The M.A.D. Therapy takes a limited number of insurance plans.

 

However, it is your responsibility to contact your insurance company to determine your in and out-of-network benefits. You may be provided with a superbill to submit to your insurance company for possible reimbursement. Please check and review your coverage carefully to ensure that you understand their answers. Here are some helpful questions to consider and/or ask:

 

  • What are my mental health benefits, deductibles and/or co-pay?

  • What is the coverage amount per therapy session and how many covered therapy sessions are covered per year?

  • How much am I reimbursed if I use an out-of-network provider?

  • Is approval required from my primary care physician?

  • How much is my deductible and has it been met?

Many factors need to be considered. Before scheduling a therapy session, be sure to contact your insurance company to verify your coverage and what portion is your responsibility. Always verify that deductible! Remember they pay nothing until you have met your deductible.

Many decide NOT to use their insurance plan. Why?

There are benefits to being private pay rather than using your insurance plan coverage.

Insurance companies require an actual diagnosis to confirm medical necessity. They need this in order to determine if they feel the services are needed and then to assist in covering. They may also request certain information (e.g., the reason for requesting services). Any of the information documented for you regarding each appointment becomes part of your personal health record. Additionally, the insurance company reserves the right to audit my files to ensure continued necessity for services. You have the right to be private pay for your services to avoid sharing your private information with your insurance company if desired.

Do I need a diagnosis?

If you plan to use your insurance, then yes, you do.

It is required by your insurance company in order for them to contribute to the bill. However, not everyone meets the criteria for a qualifying diagnosis and some seek services to improve certain areas of their daily life. In order to avoid having a diagnosis on your eternal electronic health records, one must be private pay.

Insurance company may dictate the therapists you can choose as most insurance companies have contracts with healthcare providers. These are the providers who are known as being in-network. Some insurance companies may not offer out-of-network benefits if you want to choose your own therapist. If you choose to see an out-of-network provider, insurance companies usually reimburse you at a lower rate, but only if your annual deductible has been met. Private pay can be a benefit as it ensures you find the right therapist for you.

What is covered?

That depends.

Many insurance companies reserve the right to limit the number of sessions they will pay for in a calendar year or the type of therapy you may participate in. Please contact your insurance to verify these coverage details. As private pay, you and your therapist will determine your course of treatment.

Please choose wisely after gathering all the details.