Sandra Sinicropi, LCSW, Montclair, NJ
     Individual and Couples Therapy
 

Insurance Information


Most health insurance plans provide some form of coverage for outpatient psychotherapy.  A call to your insurance company can help you determine the mental health coverage provided by your plan.  In-network benefits cover psychotherapy with professionals who sign contracts with the insurance company to provide services at a set rate.  The insurance company oversees the treatment, authorizing the number of sessions allowed for a particular condition.  The total number of sessions covered is usually limited to 20 or 30 sessions.


Out-of-network benefits cover psychotherapy with the professional you choose.  Most plans require the patient to pay a deductible, and then reimburse a certain percentage of the fee after that, typically 75 or 80%.  Some plans limit the number of sessions or the dollar amount that are reimbursable each year.  The psychotherapy is not managed, and authorization is usually not required.  Some insurance companies will agree to reimburse the professional directly at the patients request so that you do not have to pay out of pocket.


My practice is out-of-network for most insurance plans.  Specific fee information is discussed at initial contact.  Fee flexibility is available according to individual financial status.


Although obtaining psychotherapy on an out-of-network basis may seem more expensive, there are many benefits.  Insurance companies require regular treatment plans to be submitted by their network providers in order to continue to authorize sessions.  There can be a lack of clarity and/or after-the-fact decisions about what they will cover, resulting in surprise balances billed to patients.  Finally, insurance companies can and do audit in-network psychotherapists’ records, further compromising confidentiality.


Obtaining psychotherapy on an out-of-network basis avoids all of these issues that compromise confidentiality and autonomy of treatment.  All treatment decisions are made solely between patient and therapist, including the type of therapy used, its length, and who should or should not be consulted.  My practice does not involve any third parties in billing or paperwork in order to insure accuracy and confidentiality.  Although my practice is fee-for-service, I provide assistance with obtaining reimbursement from insurance companies.