Question 1

Confidentiality & Medical Necessity

Accepted Answer

Many people wish to keep the details of the sex lives private. Therapy is by nature confidential, and nobody but you may access your file. However, there are exceptions to this, particularly when there is the possibility of imminent harm to yourself or others or if a judge requires your medical records.

Another exception is when using insurance to cover the cost of your care. Your insurance may request your session records at any time as a condition of plan membership and has the right to determine whether your care is "medically necessary". If at any time your insurance decides your care is not medically necessary, they may refuse to cover it. Your clinician will document details about why your care is a medical necessary and details about your treatment in your medical record. Clients whose care does not meet a minimum bar for medical necessity include those without a diagnosable mental health disorder.

If you are concerned about third party access to your healthcare record, private pay offers the highest level of confidentiality.

Please feel free to reach out with any questions or concerns. More detail about your right to confidentiality is provided in your intake packet.

Question 2

Does insurance cover couples counseling?

Accepted Answer

Despite the well known mental health impacts of relationship health on mental health, insurance providers do not cover the cost of relationship therapy. In relationship therapy, the relationship itself is "the client" and the focus of treatment. Relationships cannot have a diagnosable mental health disorder, and treatment is therefore not considered "medically necessary".

However, clients who are seen for individual counseling may have sessions where their partner is present covered when it is necessary to the treatment of their mental health diagnosis.

Question 3

Out-Of-Network Coverage (Super Bills)

Accepted Answer

Superbills allow you to get reimbursed for sessions when using out-of-network benefits.

Not sure if you have out of network benefits? The easiest way to find out is to simply call the number on the back of your insurance card. Ask if your plan has out-of-network benefits. Make sure to ask how much your insurance reimburses, whether your deductible needs to be paid off first, and how to get reimbursed.

If you'd prefer not to call your insurance company, you may be able to use your online health insurance portal instead:
	1. Log in to your health insurance's portal online. Their website is on your insurance card.
2. Locate a document called "Summary of Coverage" or "Summary of Benefits". This is usually the first document on your homepage/dashboard. 
3. Find the mental health coverage details on the document (as plan documents are long, CTRL+F will bring up a search box and you can type in "mental health" or "behavior health" to help you find it). It will state if you have out-of-network coverage. 
4. Note how much your insurance reimburses, whether your deductible needs to be paid off first, and how to get reimbursed.

Question 4

Good Faith Estimate

Accepted Answer

As a paying client, you have the right to receive a "Good Faith Estimate" determining how much your mental health care will cost. Under the law, health care providers need to give clients who do not have insurance or who are not using insurance an estimate of the expected charges for medical services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare service, including counseling services. You can ask your provider for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate you can dispute the bill. You will receive a copy of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

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