Your Investment in Yourself
Fees & Insurance
We aim for transparency.
As Lotus Counseling operates as a collective of individual business owners, each provider manages their own scheduling, session rates, insurance company negotiations and billing at their own discretion. Information provided on this page serves as a general overview to guide your understanding, but speaking with your individual provider is the only way to fully understand your investment.
We know medical billing and insurance companies can be overwhelming to navigate, even on the best of days. Each provider will do their best to support you in understanding your benefits and out of pocket costs.
Checking Your Insurance Benefits
Although as providers, we would love to play the “how long can insurance have us on hold” game so that we could provide you with a crystal clear understanding of your benefits, we don’t always have the capacity to do that (most of us are one human operations) and even when we do, the first thing they tell us is that they cannot guarantee the accuracy of the benefits information they are providing. This means it is ultimately your responsibility for knowing and understanding your plan’s benefits. In order to help, here are some questions to ask your insurance company regarding eligibility, benefits, payments and insurance responsibility for services. Depending on your benefits it is possible for services to be somewhat covered by your plan or in incredibly rare instances, fully covered. Keep in mind not all of our providers work with insurance companies and not all services offered by our providers are services that insurance companies cover (for example: psychoeducational groups, workshops, some couples therapy, EMDR intensives, and therapy where a client chooses to forgo a formal diagnosis).
We’d recommend asking these questions to your insurance provider to help determine your benefits (In-Network):
What’s my deductible for in-network mental health coverage?
How much of my deductible has been met for the year?
Is there a limit on sessions my plan will cover per year? (If yes, how many?)
Does my policy cover 53 minute sessions (Billing code 90837)? (If yes, how many?)
How much is my copay, or coinsurance, for outpatient mental health services?
What is the policy year (i.e. Jan 1 – Dec 31)?
Does my plan require a referral or pre-authorization for psychotherapy?
Does my policy cover telehealth/teletherapy/tele-mental health/virtual visits using a secure HIPAA- compliant platform?
We’d recommend asking these questions to your insurance provider to help determine your benefits (Out-of-Network):
Does my plan include out-of-network coverage for mental health services?
What is my out-of-network deductible for mental health? Is this separate from my in-network deductible?
How much of my out-of-network deductible has been met for the year?
Am I limited by the number of sessions I can have per year? (If so, how many?)
What is my out-of-network out-of-pocket maximum per year?
What is my out-of-network coinsurance for mental health services?
Do I need a referral to see someone who is out-of-network?
What is the policy year (i.e. Jan 1 – Dec 31)?
Does my policy cover telehealth/teletherapy/tele-mental health/virtual visits using a secure HIPAA- compliant platform?
How do I submit forms for reimbursement? (Superbill)
Still Have Questions?
Your therapist is going to be the best person to handle any questions you have about insurance and financial investment in your wellness. Each provider will have detailed informed consent and practice policy documents for you to sign that will clearly outline your financial obligation, late cancellation fees, expectations regarding payment and rates for sessions.
Good Faith Estimate
You may request a Good Faith Estimate from your provider prior to starting therapy services. These estimates will outline expected charges over the course of treatment. The No Surprises Act requires healthcare providers and facilities to provide a good faith estimate for services provided. Providers licensed by the Ohio Counselor, Social Worker & Marriage and Family Therapist Board have long been required to do this as part of our informed consent process. Our informed consents are required to outline the actual cost of sessions and are provided to and signed by clients prior to the first session. While we will provide you a Good Faith Estimate if requested, please note that it is difficult for us to estimate how many sessions you will need prior to completing a full evaluation of your presenting concerns and it is unethical for us to provide you with a mental health diagnosis prior to completing a diagnostic assessment.
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a medical plan or have coverage or eligible for a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your rights to a Good Faith Estimate, visit www.cms.gov/nosurprises