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Foggy Lake

Insurance Information

DO You accept insurance?

Currently I do not accept insurance directly because I am not paneled with any insurers. While I would love to make my services more accessible in this way, there are many reasons it is not possible for me at the moment. I'm happy to answer questions about this, and you can find out more at the bottom of this page. 

However, I do provide superbills. Clients with insurance plans that accept "superbills" from out-of-network providers (often PPOs) are able to get partial or full reimbursement from their insurance providers. This means that clients pay upfront for therapy and then seek reimbursement from their insurer by submitting superbills. 

Unfortunately, I'm not able to guarantee reimbursement from your insurance provider. If you are unable to afford sessions without insurance reimbursement, I recommend speaking directly with your insurance provider beforehand.

If you'd like to know whether your insurance will reimburse you for services, I recommend following the steps outlined below.
 

Tips for Navigating out-of-network insurance coverage of mental health services

Here are some tips for speaking with your insurer to find out about out-of-network mental healthcare coverage:

#1: You will want to find your insurance provider's "behavioral health" line or "member services" line. Both phone numbers are typically found on your insurance card or on the website for your insurance. You can also use a search engine to find these numbers.

 

#2: Call that number and ask your health insurance provider the following questions:

  • "Do I have 'out of network coverage' for mental or behavioral health services?

    • (if no, this means they will most likely not reimburse for our sessions).

#3: If they say yes, they do reimburse for out-of-network therapists, then you may want to follow up with these questions:

  • "Are there any limitations that would cause you to *not* reimburse me for a session with an out-of-network therapist?"

    • Some insurers may have added requirements that would hinder your ability to get reimbursed.

  • "Are there any steps required to authorize coverage of therapy sessions?"

    • Some insurance companies will require that an in-network provider, such as your primary care physician or psychiatrist, provide an authorization or referral stating your medical necessity for services. Sometimes this authorization may need to be renewed on a regular basis (often every 3-6 months). 

  • "What steps are required to submit a superbill, and how long does it typically take to receive reimbursement?"

    • This will give you information about how to submit the superbills your therapist gives you to your insurance company for reimbursement. They can also give you a sense of how long you will have to wait between paying upfront for therapy and getting reimbursed by your insurance.

  • "How soon after a session must a superbill be submitted?"

    • Often insurance companies will have time limits on submitting superbills.  This varies by company but is typically between 2-6 months after your session with a therapist.

  • "How high is my deductible and have I met it yet?"

    • (this tells you how much you will need to spend out of pocket before your sessions are able to be reimbursed by insurance).

  • "What is my required copay/coinsurance?"

    • In other words, what percentage of the cost are you required to cover yourself, and what percentage will your insurance cover? (This will help you determine whether you will receive partial or full reimbursement).

  • "Do you make 'single-case agreements' and what is the process for establishing a single-case-agreement?

    • Some insurance providers who don't usually cover out-of-network providers will still cover certain services under a "single-case-agreement". Typically this is justified when the outside therapist has a clinical specialization that is not available among their in-network providers. 

    • (Personally, I do not yet work with single-case agreements as they present similar challenges as working with insurance directly. However, many therapists who are not paneled with insurers will work with single-case agreements.)

#4: When speaking with your insurance company, you may be required to provide certain information including therapist credentials, therapist zip code, and CPT codes.
 

  • My therapist credentials are: Myles Marcotte, registered Licensed Clinical Social Worker, #122838

  • My NPI number is: 1992219224

  • I am supervised by Erica Folinsky, Licensed Clinical Social Worker #70793.

  • The zip code for the therapy practice I work under, Your Healing Begins Here, is: 90027 (Los Angeles, CA)

  • The zip code associated with my license and residence is: 90814 (Long Beach, CA)

  • The practice address is: 2320 N Commonwealth Ave, Los Angeles CA 90027

  • The practice phone number is: 818-217-0039

  • The CPT codes I use are as follows: 90791 (for your first appointment) and 90834 (for ongoing individual appointments).

I know this can be an overwhelming process. I hope this guide helps you to navigate your insurance provider!  

Tips for finding In-network providers

If you are looking for a provider who is covered directly by your insurance there are few main ways to look.

 

One is to find find your insurance company's behavioral health directory. You can usually find this by googling "[insurance company name] behavioral health directory", but you should also be able to find out by calling the customer service or behavioral health phone numbers on your insurance card. The directories often have limited information about the available providers, but you can then plug their names into google to search for their websites or other directory listings that may include more details.

 

The other method is to search for a therapist on a directory like Psychology Today (see my directories page for more options) which allows you to filter by insurer. Just be mindful that if you scroll too far in a directory search, you may end up seeing results listed for therapists not covered by your insurer. So it's good to double check the insurance they have listed on their individual page before reaching out.

The third method is to search however you prefer for a therapist (google, alternative directories, etc) and reach out to the therapist to inquire directly about insurance coverage. Most providers will have their insurance policies listed clearly on their website, but sometimes therapists do take a while to update our websites with information like new insurance panels. 

Why don't you accept insurance?

I would love to accept insurance because I believe mental health care is a vital service that should be free for all. I require insurance to afford my own therapy so I understand the need on a deep level. Unfortunately, insurance companies have taken great pains to make the process of working with them so inaccessible, risky, costly, labor-intensive, and ethically compromising that many therapists choose to bypass the process completely. 

To begin with, insurance companies frequently take weeks or even months to pay clinicians after sessions. This isn't feasible for the many therapists who live paycheck to paycheck. When sessions are covered by insurance, the reimbursement is frequently very low, often less than half the market rate for therapy in the area. Insurance companies also regularly fail to increase wages with inflation. The lower wage of insurance reimbursement must cover more hours of work since taking insurance can add significant time outside of sessions spent speaking with insurance providers, learning to use their systems for payment/documentation, negotiating with their billing departments, etc. Additionally, the process to get paneled with insurance can take many months or even years.

 

As a disabled therapist, I must work limited hours if I want to sustain my health. With all these factors considered, the wages provided by insurance cannot provide a liveable income for me. Working with insurance directly is a compromise I am unable to make without sacrificing my well-being significantly and compromising my ability to remain in the field long-term serving my communities.

Working with insurance also presents other significant risks and limitations. Insurance companies are notorious for "clawbacks". Clawbacks are a common practice where insurance companies will come back months or even years after sessions with a client and claim that the sessions should not have been covered for one reason or another.  When this happens, the therapists are typically required to pay back the insurance companies. Clawbacks can cost thousands of dollars and often come as a complete surprise. Many therapists do not have the financial savings to handle the surprise costs of clawbacks.

Working with insurance can also create limitations on how we do our work. For example, sometimes insurance will only cover therapy for autistic clients if the therapeutic modality is something like ABA (Applied Behavioral Analysis). ABA therapy is widely considered to be a modality that can cause great harm and even traumatize autistic clients.
 

Unfortunately, working directly with insurance is not a viable option for me at the moment in the context of a system that exploits healthcare workers for profit alongside our clients and patients. I will continue to fight for systemic change, offer lower-cost spots as I'm able, and work to have enough financial stability to someday be able to weather the risks associated with accepting insurance. For now, please refer to the above resources to find out about insurance reimbursement through superbills or to find a provider who can weather those risks and offers therapy services through your insurance provider directly!

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