Using Private Insurance
If you have a private health insurance plan (not Medi-Cal or Medicare), there are important things to understand about your coverage.
In-Network Providers
Your plan probably has contracted “in-network” providers. In-Network providers are only allowed to bill the “allowed amount” set by your insurance plan. This can save you money, but it limit which therapist you can see. Typically you can choose to:
-
See an In-Network therapist and let them bill your insurance.
-
See an Out-of-Network therapist and receive a Superbill that you can submit to your insurance plan for possible reimbursement.
-
Opt out of using your insurance altogether, and agree to a self-pay rate.
Our In-Network Plans
If you have private health insurance, with the following insurance plans, we can bill in-network for your therapy.
Blue Shield
Anthem/Blue Cross
Aetna
TriWest
Carelon
Medicare (Original Medicare)
Medi-Cal (some plans) (see which plans)
Shine a Light can bill in-network for these plans. You will pay the full allowed amount until your deductible is met. Then you will only have to pay your copayment.
Out-of-Network Options
If you have a private insurance plan not listed here, we may be able to help you. You will have to pay the full fee up front.
We can give you a Superbill that you can submit to your insurance company to receive any out-of-network benefits your insurance plan has. The amount of repayment will depend upon your plan’s policy. Some plans do not reimburse clients for Superbills. It is your responsibility to determine if your plan has out-of-network benefits.
Learn More about Out-of-Network Options
Find out what your Out-of-Network benefits are.
Understanding Your Benefits
It is also important to understand what your potion of the payment to the therapist will be. There are three key terms to know.
Allowed Amount
This is the maximum amount an in-network therapist can charge. You will never owe more than this amount if you use an in-network therapist. But you will have to pay this full amount until your deductible is met.
Deductible
This is the amount of medical payments you must pay, in full, each year before your insurance plan begins to pay anything. If you have a high deductible, you will pay for all your care until it is met.
Copayment (Co-pay)
This is the amount of the therpist’s fee that you must pay yourself. It is usually between 10-30% of the allowed amount. But it might be a fixed amount of $15-$40. After your deductible is met for the year, you will only have to pay your copayment. Your insurance will pay the rest.
Denied Claims
Unfortunately, sometimes insurance companies will deny payment on a claim. Whenever this happens, the client is responsible for payment of the full fee. Please note these common reasons for claim denials so you can prevent them.
Not Eligible
- Coverage may be terminated due to a change in policies, change in job or location, or nonpayment of premium.
Other Insurance
- Another insurance policy may be “primary”. If we are not in-network with the other plan, we may not be able to bill either plan.
Deductible Not Met
- When the deductible is not met, the claim may be accepted, but no insurance payment is made.
Request an Appointment
We have openings in all our offices and via telehealth. You don't have to wait around on a wait list. Use our form to get matched with a therapist who will be a good fit for you.