We have tried to cover answers to all the insurance questions that we get from clients. If we missed something, please do not hesitate to ask your therapist.
We have chosen to remain an “out-of-network” provider for all insurance companies. In our experience, this allows us to provide the highest quality of care, independent from insurance-based rules or decisions.
It is your choice whether you would like to apply for insurance reimbursement or not. Usually insurance companies will pay a portion of your spending, depending on your policy. As such, if you decide to seek reimbursement, we provide a “superbill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the superbill to your insurance company for reimbursement.
Please note that we do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.
AUTISM SPECIFIC INFORMATION
California’s autism insurance bill, SB 946 (2012), Cal. Insurance Code § 10144.51 (2017) and Cal. Health and Safety Code § 1374.73 (2017) require health insurance policies in California to provide coverage for behavioral health treatment for pervasive developmental disorder and autism. This often includes assessment and diagnosis. The specifics of actual insurance coverage vary greatly between insurance providers and policies. We highly recommend that you contact your insurance providers so that you fully understand the extent and limitations of your coverage.
PAYMENT, INVOICES, AND SUPERBILLS
Also, please note that:
Payment for therapy is due when the therapy takes place. Using our online system (called Simple Practice), your credit card will be charged automatically at midnight on the day of your session.
You will automatically receive a monthly "invoice for services" on the 1st day of the month for appointments during the prior month. This invoice will NOT have a diagnosis and other information necessary for submission to your insurance company.
You can request for a monthly Superbill as well, which can also be automatically generated on the 1st day of the month for the prior month's appointments. This will have all the appropriate insurance documentation. Some clients prefer to request the Superbill as needed or once per year. Also, some clients chose not to submit to the insurance company in which case a Superbill will NOT be created.
You can log into the online portal and download your invoices and/or Superbills at your convenience.
For reimbursement by insurance companies, you must have a diagnosis. If you do not fit an ASD or ADHD diagnosis, you may still fit a diagnosis for a milder condition such as an "adjustment disorder". Please discuss this with your therapist.
SERVICES OUTSIDE OF CALIFORNIA:
Our therapists are only licensed to practice psychotherapy in California. Outside of California, they only provide coaching services. Coaches can NOT provide a medical diagnosis while psychotherapists can do so. Since most insurance companies do NOT reimburse for services unless a medical diagnosis is provided by a psychotherapist, it is unlikely that coaching will be reimbursed for non-California residents.
HSA AND FSA ACCOUNTS:
Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.