We believe in integrity and openness in our financial agreements with you. While we know that talking about money can bring up a lot of sticky feelings, as therapists our job is to wade into the heart of uncomfortable subjects and we won’t let this be the exception. As trained and licensed therapists, you are choosing us to assist you in one of the most important aspects of your health. You have to place a tremendous amount of trust in us and we take this responsibility seriously. We chose this career based on our desire to use our skills and training to help others live happy, healthy lives. We are also working to support ourselves and our families. Although we are not able to make aggressive changes to our fees, we are willing to make adjustments to be able to work with you or when unexpected life emergencies occur. We will do our best to work toward a solution, so if you need to, be fearless! and ask.

INSURANCE

Blue Cross Blue Shield

Blue Care Network

McLaren Health Plan

For your assistance, We have created a list of questions to ask when contacting your insurance company about your coverage. We encourage you to use them and to write down the name of the person who supplies the answers.

If you wish to use an insurance not listed above, all is not lost! You can contact your insurance company to determine if your plan has out-of-network (OON) coverage.  Either we will be able to bill them directly or you pay us directly for your sessions and then we provide a “superbill” that includes all the information that your insurance company requires to reimburse you, for all or part of our fee. We are happy to assist you with the submission process. 

Questions to Ask Your Insurance Company

+ Do I have coverage for outpatient behavioral health? Give the agent the CPT code for individual psychotherapy: 90837.
+ How much is my Deductible? How much has been met? Ask them to explain how your Deductible works.
+ What is my copay or coinsurance once the deductible has been met?
+ What is my coverage for Outpatient, Out of Network Psychotherapy? Depending on your specific plan, after meeting your deductible, insurance companies will typically reimburse between 50%-90% (ask your representative for the specific amount your policy allows).
+ Are there any restrictions, such as a required authorization or a referral, or anything else that may be required to be reimbursed?
+ Is there a limit to the number of sessions I am allowed per year? Does my therapist need to submit a form or treatment plan? If so, please inquire as to how this may be obtained.
+ ALWAYS get the name of the individual who quoted your benefits and a reference number, if applicable.

Why Not Insurance?

We are currently out of network for most insurance plans for several reasons.

• Some insurances require authorization for therapy services, meaning you or your doctor must justify the need for therapy vs. allowing you to make this decision for yourself.
• All insurance companies require a mental health diagnosis to be added to your permanent medical record before approving services. Many people are suffering due to life circumstances such as work burnout, divorce or grief; these are not mental illnesses.
• Diagnoses are stored and kept forever and this can have implications for those who wish to join a health profession or the military.
• Insurance companies often restrict the length of treatment and the type of services that can be offered and require lengthy reviews and documentation to support using therapy (for example, some companies are trying to restrict the therapy session to 45 minutes versus the traditional 55 minutes. That is not much time to talk once a week).
• With HMOs, individuals have to select a provider solely based on their in-network participation, not on the provider’s experience, skills or expertise.
• When therapists are in-network with insurance, they must agree to allow auditors to review your therapy records. Despite HIPAA laws, non-clinical auditors can review your records any time they want.
• Failing to realize that a one size fits all approach is not effective nor in the best interest of the individual. The length of time spent in session, the type of therapy and where it is conducted should all be decisions that you and your therapist make, based on what is most effective for you. 
• Many insurances have in-network mental health deductibles that are so high it won’t save you any money to stay in-network, so why not see someone of our own choosing who is out of network?

Good Faith Estimate

A Note regarding the “No Surprises Act” from the Owner of IAM.
We are Private Pay Practitioners. This means:

• We are NOT contracted as an In-Network Provider with any insurance companies. As such, we cannot provide you with any information regarding your in-network benefits or potential reimbursement from your insurance plan.
• We encourage prospective clients to call their insurance company regarding any and all financial questions and concerns, including their ability to submit claims for potential reimbursement, should they be interested in doing so.
• Bottom Line – We believe that the most successful and effective therapy begins with honesty and trust, which is why we support the No Surprises Act and provide all new clients with a GFE. Legally, you always have the option of choosing a provider within your insurance’s network and it is important that you know your choices. I want potential clients to treat The Good Faith Estimate as their expected cost of treatment within our practice. Our clients have access to their GFE, via the practice’s HIPAA-compliant, secure portal. We welcome any and all questions that you may have regarding the GFE, our fees or any other aspect of the Practice. Please feel free to contact us via email or phone. Thank you.

Respectfully,
Susan Beckman-Mitchell, MA, LPC IAM Practice Owner
IAM Phone Number: 269-888-3353
MI Lic No. 6401001487
Integrated Anxiety Management, LLC
Email connect@IntegratedAnxietyManagement.com
Practice Website IntegratedAnxietyManagement.com
NPI2 1992450126
Tax ID 88-0631912

Understanding The No Surprises Act of 2021 & The Good Faith Estimate
Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.

How Does This Relate to Receiving Mental Health Care? 
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are CHOOSING not to use their health insurance, a formal estimate of the expected charges for medical services, including psychotherapy services, referred to as a Good Faith Estimate, herein referred to as a GFE. You have the right to receive a GFE for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your GFE, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises. or call 1-800-MEDICARE (1-800-633-4227).

This law was enacted to protect consumers. By providing clients with a formal copy of their anticipated charges via the “The Good Faith Estimate,” they can knowingly choose a clinician that is right for them and begin therapy with an accurate understanding of the anticipated cost of these services.

Good Faith Estimate Defined
A Good Faith Estimate is a notification of expected charges for a scheduled or requested item or service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service.[vii] The expected charge for an item or service is the cash pay rate or rate established by a provider for an uninsured or self-pay patient, reflecting any discounts for those individuals.[viii].

Providers and healthcare facilities must furnish a good faith estimate of expected items or services on or after January 1, 2022, which will allow uninsured or self-pay individuals to have access to information about healthcare pricing before receiving care. The purpose of the GFE requirement is to give individuals an opportunity to use the information to evaluate their healthcare options, manage care costs, and prevent surprise billing.

Good Faith Estimate Content Requirements
The Good Faith Estimate provided by the convening provider or facility must contain the following information:

• Patient name and date of birth
• Description of the primary item or service in clear and understandable language as well as the date of service, if applicable (e.g., 55-minute individual psychotherapy session; DOS)
• Itemized list of items or services (e.g., 55-minute individual psychotherapy session, weekly until otherwise indicated)
• Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service[x]  (Note: Providers may have diagnoses for existing patients; however, prospective/new patients may not yet have a diagnosis and thus, this information may not be available. The provider should reasonably attempt to include expected service codes and expected charges associated with the service.)
• Name, National Provider Identifier (NPI), and Tax Identification Number (TIN) of each provider/facility represented in the good faith estimate[xi] and the states and office or facility locations where the items or services are expected to be furnished.
• Disclaimers regarding additional items or services that are recommended that must be scheduled or requested separately, that the good faith estimate is only an estimate and that actual charges may differ, and that the patient has the right to initiate the patient-provider dispute resolution process if the actual bill charges substantially exceed the expected charges in the good faith estimate, and that the good faith estimate is not a contract and does not obligate the patient to obtain the items or services from any of the providers identified in the good faith estimate.[xii]

Note: If any information provided in the estimate changes (i.e., a provider raises fees or the agreement for the frequency or type of services changes), a new GFE must be provided no later than one business day before the scheduled care. Also, if there is a change in the expected provider less than one business day before the scheduled care, the replacement provider must accept the GFE as the expected charge.

*Information courtesy of https://www.camft.org/Resources/Legal-Articles/Chronological-Article-List/the-no-surprises-act-what-mfts-need-to-know