Insurance, Fees, and Payment Policies
Fayetteville Psychotherapy Associates, PLC, is committed to providing quality psychotherapy services. Each therapist has estabished his or her fees in keeping with their individual training and experience as well as the fees generally charged by providers in the Northwest Arkansas area.
Each therapist practices independently and sets his or her own individual fee schedule.
- The fee for an initial (Intake) session is $250.
- The fee for subsequent sessions is $155.
- Fees for other services are available upon request.
- We do not offer sliding-scale fees or payment plans for therapy services.
Payment of all applicable copays, deductibles, and fees is due at the time of service. Our office accepts payment by cash, check, Visa, MasterCard, and Discover credit or debit cards.
Most insurance policies provide at least some coverage for mental health benefits. To assist you in accessing our services, our providers participate in a number of major insurance networks and we will file insurance on your behalf for your visits at your request. However, it is important to remember that you are responsible for:
- Obtaining the initial referral to your therapist (when required by your insurance plan).
- Obtaining pre-certification/ authorization for visits (when required by your insurance plan).
- Keeping track of your benefit limits.
- Paying all deductibles, co-pays, and other charges not covered by your insurer.
- Informing our office of any changes to your insurance coverage.
- Payment of all charges not reimbursed by your insurance carrier. (We will work with you and your insurer to resolve any claim denials, but payment of all fees for services is ultimately your responsibility.)
- Some of the insurance networks in which Dr. Spaine and Dr. Kling participate are:
- Arkansas Blue Cross/ Blue Shield (excluding the Federal Employee Program)
- BlueAdvantage Administrators
- Washington Regional Employee Insurance
- Health Advantage
- We do not accept Medicaid or Medicare
- Please note that this is not a complete list and is subject to change without notice. Please contact your insurer to verify your therapist's current participation in your specific plan.
Cancellations/ Missed Appointments
The scheduling of an appointment exclusively reserves your therapist's time to meet with you. If you fail to cancel an appointment or you miss your appointment, we are unable to offer your reserved time to another patient. Missed appointments or appointments cancelled for non-emergency reasons with less than 24 hours notice will be billed at the full session rate directly to the patient. Insurance companies do not pay for missed sessions.
Returned Checks/ Denied Credit Card Charges
A $25.00 fee will be charged for all returned checks. Patients are responsible for promptly making valid payment on any returned check or denied credit card charge.
Understanding Your Mental Health Insurance Benefits
Most insurance plans provide at least some benefits to help their plan members pay for therapy services. To get the most out of your insurance benefits, it is important to get the right information about what your insurance plan does and does not cover, and what your responsibilities are as a plan member. It is also important to consider not only the benefits of using your mental health insurance benefits, but the possible disadvantages as well.
Depending upon your insurance coverage, yoru insurance carrier may pick up a significant part of the cost of your therapy. Recent changes in health care laws have reqired most plans to "level the playing field" and require greater access to mental health services for their members.
When using medical insurance, your therapist must provide a diagnosis to the insurance company in order to file claims on your behalf. Many insurers also require therapists to file "treatment plans"--reports that describe your ongoing progress in therapy in order to obtain approval for additional sessions on your behalf. Each time a claim is filed or a treatment plan is submitted it becomes part of your medical record. If you seek out an individual health or life insurance policy in the future, or are involved in a court proceeding (such as a divorce or custody proceeding), it is possible that this medical record may be sought out and used against you.
You Do the Math:
In adding up the pluses and minuses of using insurance, it is up to each individual patient to determine his or her own comfort level in deciding whether or not filing insurance is right for him or her. For some individuals, the potential financial benefits of having insurance help pay a portion of the fees for their visits with their therapist far outweighs any concerns about current or future privacy issues. For other patients, the notion of insurance becoming involved in what they view as a very private and personal process with their therapist is not acceptable. We will work with you and respect your decision either way.
IF YOU DECIDE TO USE YOUR INSURANCE BENEFITS:
We strongly encourage all patients who plan to use their mental health benefits for therapy services to contact their insurance provider to get specific information about their plan prior to starting therapy. Even if you are very familiar with your plan's medical benefits, you may find that how your insurance company handles mental health benefits is different.
Checking on Your Benefits
To help you determine what your benefits are and maximize the benefits you receive from your plan, you may wish to download our "Checking on Your Mental Health Benefits" worksheet. This worksheet provides a list of specific questions to ask your insurance company when you call to verify your mental health benefits. With this information, you should be able to determine what your out-of-pocket costs will be and what steps you will need to take to maximize the benefits you receive through your insurance plan.
While we do file insurance claims on behalf of our patients, it is important to keep in mind that each patient is ultimately responsible for all non-reimbursed costs. Denied claims, deductibles, co-pays, missed session fees, late cancellation fees and all other non-reimbursed costs are the responsibility of the patient.
TERMS YOUR INSURANCE COMPANY MAY USE:
This is the amount you must pay out of your own pocket to your therapist before the insurance company will begin making payment to the provider.
For instance, if you have a $250 deductible, the first $250 in therapy charges will be payable directly to the therapist by you rather than by your insurer. After you have "met" (i.e. paid) the $250 in deductible charges, your insurer will begin paying its portion of the charges.
Some plans may require that you meet a separate mental health deductible. Be sure to ask your insurer if your mental health and medical deductible are the same.
Most plans require you to meet your deductible on a calendar-year basis. This means that your deductible is "reset" at the beginning of each year and beginning January 1st you will need to meet a new deductible. Some plans run on an annual deductible that does not coincide with the calendar year.
Coinsurance is the amount you owe after the insurance company has paid its portion of the charges. For example, if your insurer pays 80%, your coinsurance, or the amount of money you pay per session, is 20%.
A copay is a flat dollar amount that must be paid each time you meet with your therapist.
Note: Your mental health copay is often different than the copay for your medical doctor. Many insurance companies list a copay amount on the front of their members' ID cards. It is important to note that this may not be the copay amount due for mental health services--this may be the copay amount only for medical or other services.
Some insurance plans require that you obtain a pre-authorization (sometimes called a pre-certification) before you see your therapist for the first time. Plans that require such authorization will not pay for visits that have not been authorized in advance, leaving the patient to pay the full fee for unauthorized sessions. If you are required to obtain a pre-authorization for services, please provide us with your authorization number or code before your first session.
To reduce costs, many insurers develop a network of providers who agree to perform their services for a negotiated rate. To encourage plan members to use services at these negotiated rates, many insurers provide greater benefits to their members when they see an in-network provider. Some plans will pay no benefits for services provided by a therapist who does not participate in their network. Plans may also require you to meet a separate, out-of-network deductible (which is often higher than your in-network deductible) if you seek services with providers outside of their network.
Some plans, typically HMO plans, require that you obtain a referral from your primary care physician prior to meeting with your therapist. These plans will not pay for therapy sessions for which no referral was obtained. Please present your referral paperwork prior to your first session with your therapist.
Session Limits/ Dollar Limits:
Most plans allow their members a maximum number of therapy sessions or a maximum dollar amount toward therapy sessions each year. Once that limit has been met, all fees for subsequent therapy sessions for the plan year or calendar year become the responsibility of the patient.
For instance, if your plan limits your visits to 20 per calendar year, the 21st and all subsequent visits will not be eligible for any reimbursement by your insurance carrier.