At Therapeutic Options we are licensed professionals and the fees for our services are reimbursable by insurance companies.
Are you in-network with any insurance companies?
Dr. Pesner is in-network with Medicare.
What is the difference between being “in-network” and “out-of-network” with insurance companies?
If you receive services from an “in-network” provider then you are only responsible for a copay. If you receive services from an out-of-network provider then you must first meet your deductible and then you pay a percentage of the fee (co-insurance).
In-network co-payments have risen significantly over the past few years. It is not unusual for these to be $40 - $50 per session. For many plans this is actually more than the co-insurance costs associated with out-of-network benefits (once the deductible is met). Many policies, particularly those issued by local and state government (teachers, policemen, municipal employees) often have a $100 - $200 deductible. Unfortunately, some plans have much larger deductibles. We can call your insurance company and find out the specifics of your plan.
What if my plan has no out-of-network benefits?
If you have Aetna, Cigna or Medicare you can access services based on the providers who participate in those plans.
In some instances clients have successfully negotiated with their insurance companies to obtain approval for our services as if we were in network. This has most frequently occurred for our social skills groups. If an insurance company does not have an in-network provider in the geographic area that offers a similar and appropriate service then they will frequently agree to reimburse for services provided by our staff. These “single case agreements” (also called “ad-hoc agreements”) have been successfully negotiated in the past with Aetna, Cigna, Oxford, United Healthcare and other, smaller companies. Somewhat less frequently clients have successfully negotiated single case agreements for individual and family psychotherapy as well. We would be happy to help you through this process.
Do you submit claims to insurance companies for your clients?
We are happy to electronically submit insurance claims forms for you. Electronic submission (which expedites payment) is available for Aetna, Cigna, United Healthcare and some other companies.
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