Insurance Coverage + Fees
Our team of compassionate and skilled therapists includes professionals who are in-network with leading insurance providers such as Aetna, Cigna, Healthfirst, MetroPlus, United Healthcare, and Medicare. This ensures that you can receive the high-quality care you need without the added stress of financial burden
Aetna Therapists, Cigna Therapists, Healthfirst Therapists, Metroplus Therapists, United Healthcare Therapists and Medicare Therapists can be found at Bhava Therapy Group.
Work with a therapist who can get you, who can help you and who may be in-network with your insurance.
In-Network Therapists with Aetna, Cigna, Healthfirst and More at Bhava
At Bhava Therapy Group, we understand the importance of finding a therapist who not only resonates with you on a personal level but is also in-network with/or accepts your insurance coverage. Our team of compassionate and skilled therapists includes professionals who are in-network with leading insurance providers such as Aetna, Cigna, Healthfirst, MetroPlus, United Healthcare, and Medicare. This ensures that you can receive the high-quality care you need without the added stress of financial burden
If you would like to work with one of our therapists and they are not in-network with your health insurance company, our billing department can help you learn about your out-of-network coverage and if/how you can be reimbursed by your health insurance provider for psychotherapy. We are here to support you in every way we can!
Are You…
Understanding In-Network vs. Out-of-Network Insurance Coverage
“In-network” means that a health insurance plan has contracted with the health care provider (the therapist) to provide health care services at a pre-negotiated rate in which the insurance company will pay the therapist directly for the service provided which may or may not include a cost-sharing portion known as a “co-pay” that you, the client, would be responsible for. In this case, there may be a deductible which is a set amount of money that needs to be met (paid first by the client) before the insurance provider begins to cover their portion of the fee, which means the client may be responsible for the full fee until the deductible is met. Health insurance will cover psychotherapy services that are based on the treatment of a DSM diagnostic code, known as a F-Code.
“Out-of-network” means that there is no contract between a therapist and insurance company and the client is fully responsible for the therapist’s fee for the service provided. Then, once the fee is paid, your therapist will provide you with a special receipt called a “superbill” that lists your payments and other necessary information (such as therapists’s license number, procedure code for service rendered and a diagnosis code) for you to submit to your insurance company to request reimbursement for a portion of the fee. Although a majority of insurance providers do provide some reimbursement for “out-of-network” services, reimbursement rates differ on a case-by-case basis.
In either instance, it is important for you, the client, to be informed about your insurance coverage. The best way to do this is by calling your insurance company prior to seeking therapeutic services and ask the following questions:
- Do I have coverage for “out-of-network” mental health services?
- If so, do I have a deductible? (a deductible is the amount of money you would need to pay first before your insurance coverage would kick in)
- What percentage of the session fee is covered?
- Is there a limit to how many sessions are covered per year?
- Do I need pre-authorization for out-of-network mental health services?
- Does the insurance company establish an expected session fee on which they base their reimbursement rate?
Your insurance company may ask you if you have a procedure or CPT code for the therapy you wish to receive. If asked, you may give them the following information for the types of services we provide and ask what their rate of coverage for each code is:
CPT code 90791 is for the initial consultation
CPT code 90837 is for weekly psychotherapy sessions
Out-of-Network Therapy Rate
As of April 1, 2024, our fees for individual therapy will be $170 per session and $200 for couples or family therapy. Lower or sliding scale fees are possible when working with a psychotherapy intern and are considered on a case by case basis when working with a licensed therapist at Bhava Therapy Group.
If you have any additional questions about how to navigate your insurance, please call us at 646-389-5801 or email newclients@bhavatherapygroup.com. Our New Client Coordinators are happy to help you through this process and connect you with an Aetna therapist, Cigna therapist, Healthfirst therapist, or a therapist in-network with United Healthcare, Metroplus or Medicare. We are here and happy to assist you with this process.
Couples Therapy Billing Procedures
Insurance companies provide reimbursement for a service provided (noted by a CPT-procedure code) that is based on a billable DSM diagnosis code (F-Code) assigned to an individual client. As such, all psychotherapy treatment plans, and psychotherapy notes need to reflect the service provided (CPT code) that is designed to treat the DSM diagnosis (F-Code).
When we provide couples therapy, we are treating the relationship between two people who form the couple; we are not treating one individual, we are treating the relationship dynamic co-created by two people. Issues that arise within the context of the couple may fall under what is known as (Z-codes), which are non-medical diagnostic codes and more descriptive in nature. An example of a Z-code is for couples therapy is:
Z63.0= Relationship Stress with Spouse or Partner.
DSM medical-diagnosis (F-codes) for a couple/relationship do not exist. Additionally, there is no CPT code that reflects true couples therapy that is provided, and insurance companies do not reimburse for couples therapy in its true form.
Our protocol for working with couples involves meeting together with the couple for the initial consultation, followed by an individual meeting with each of the two partners (2 additional individual sessions) for individual assessment, and then reconvening together again with the couple (for the second and subsequent couples sessions). The self-pay fee for couples therapy is $200 per session.
From time to time, your couple’s therapist may suggest meeting individually during the course of your couple’s therapy. Any individual meetings with your couple’s therapist regarding your couple’s work would also be self-pay at $170 per session. If the individual session is related to a billable DSM diagnosis code (F-code) and we are in network with your health insurance, then it is possible that the initial individual consultations and any subsequent individual sessions during the course of the couples therapy may be billable to your insurance. That is dependent upon the nature of the meeting and if it is in service of treating the individual’s diagnosis or the couple’s relational issue.
Please see the summary of codes below for easy reference:
F-code = a medical DSM diagnosis and reason for a visit that is covered by insurance
Z-code = a non-medical diagnostic reason for a visit that is not covered by insurance
CPT code = the service/procedure provided by the therapist
An F-code + A service provided = insurance will reimburse
A Z-code + A service provided = insurance will not reimburse