Insurance

IMPORTANT!- It is your responsibility to understand the requirements of your own insurance plan before you come for a visit. Dan Bolton, LMHC's office may call your insurance provider as a courtesy to clarify the details of your plan. If your insurance does not pay for your services, you are responsible to pay your agreed upon fee as detailed in the Treatment and Fee Agreement you signed at your first session. 

Billing Process


1) Some insurance networks I am In-Network with, and others I am Out-of-Network. Some insurance policies have Out-of-Network benefits that allow you to see providers not within your insurance's defined network of providers. Some do not. It is important verify this ahead of your first appointment and I am happy to help do so to eliminate any confusion or unexpected problems with billin the insurance.

If I am In-Network the billing process is straightforward- you pay your co-payment for each session, and I will bill the insurance to receive the remainder of the amount due for the services I provided. Out-of-network benefits typically, but not always, require the member to pay a deductible for a portion of the initial services, then a "co-insurance" instead of a co-payment. They also handle reimbursement differently as explained below in #2.  
 
2) Different insurance companies reimburse for Out-of-Network services in different ways. Some send the checks directly to the member. Some send the checks directly to the provider. Your current insurance company will have their own chosen policy regarding this. I have no control of whether their policy is to send the reimbursement to the provider or you, the member (other than making clients file the insurance claims themselves which I do not do currently as explained below in #3).
 
3) Most therapists when working with clients Out-of-Network do not submit the claims for their clients. They require the client to submit the claim themselves if they want to be reimbursed. I know that filling out claims can be complicated and onerous, and it is easy to make an error that could become overwhelming for somebody who has not dealt with insurance claims. I choose to do this for my clients as a courtesy. I am not required to. That is extra time I’ve taken out of my day to submit claims on your behalf to make this process easier on my clients.
 
It is an important value of mine to go above and beyond in my work, and in this case shield my clients from any confusion or hassle from the insurance and billing end of our reationship so that my clients can focus their attention and energy on the process that they've hired me for.
 

Using Insurance vs. Paying for Therapy Yourself 


You can pay for therapy in one of two ways: you can pay yourself (out-of-pocket) or use your health insurance. There are advantages and disadvantages to each. 

Using your insurance means that a 3rd party, the insurance company (and whichever of their employees is making decisions on their behalf) will be reviewing many of the decisions we make together about your therapy. I will be required to diagnose you with a mental disorder (like and Adjustment Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder). Typically insurance will cover the first 8-12 sessions regardless of your diagnosis. Most plans then will not pay beyond 12 sessions unless you have a Biologically Based diagnosis. Health insurance will pay for most of the cost of the therapy, minus whatever your health insurance determines your Copayment to be. Depending on your health insurance, and what they determine about the reason you are seeking therapy, your health insurance may agree to pay for fewer sessions than you and/or your therapist feel you need.

Self-pay allows for more privacy and does not leave your Private Health Information in the hands of an insurance company. For self-pay clients, your files are locked away and no one is able to see them except me unless, at some point, you request that I share them with someone else (e.g. your physician etc.). If you want to keep your issues private and the paper trail to a minimum, using your insurance will not afford you the level of privacy you desire. Self-pay can be more expensive upo front, depending on the particular issue you wish to address and how long therapy lasts. Self-pay may save you money in the long run. For example, if you buy Life Insurance the investigators get a release from every health care provider you've seen. If you have a diagnosis they are concnered about the cost of your premiums will go up significantly. 

Make an Informed Decision

Dan does accept some insurance plans: Tufts, most Blue Cross Blue Shield plans, some Harvard Pilgrim plans, some United Healthcare plans.

Insurance Terms to Familiarize Yourself With:

Deductible: The amount of money you are required to pay (out of pocket) before your Insurance Plan is used. This is usually a yearly amount that operates on a calendar year. So, at the beginning of each year the deductible is in effect again. There are separate individual accounts and total family accounts.

Co-Insurance: This is similar to a Co-Payment, but different in the sense that the amount is a percentage of the fee for each session. The most common Co-Insurance percentage clients are responsible for is 20% (while the Insurance Company pays 80%), but can vary between Insurance Plans. 

Co-Payment: A fixed amount clients are required to pay at the time of service. 

Health Savings Accounts: Both employers and the Insured (you) contribute to a Health Savings Account, with very specific rules and limitations on how the funds in that account are used. Receipts must be submitted for reimbursement: often employers provide a debit card. 

* Dan Bolton, LMHC does accept Debit Cards from Health Savings Accounts (aka Benefit Cards)