Fees & Insurance

Fees

My fee is $150.00/50 minute session. I am not an in-network provider with any insurance companies except CenCal Insurance. The amount that your insurance company may reimburse you for my services is determined on a case by case basis by the insurance company, based upon your policy provisions, when you submit a superbill. See below for more information.

How Insurance Works

In-Network Providers: Some Marriage and Family Therapists (MFT's) sign contracts with insurance companies to provide services and are reimbursed by insurance companies at a fixed rate. These contracted therapists are called "In-Network Providers". Insurance companies prefer that you use In-Network Providers. The contracted reimbursement rates are typically much lower than the rates most MFT's charge for services. For example, most MFT's charge about $120-$150 for a session. Insurance companies will reimburse In-Network Providers typically in the range of $55 to $80 for a session. About $68 is average.

Out-of Network Providers: Many insurance companies will also reimburse if you receive services from an Out-of-Network or Non-Contracted Provider. This reimbursement works differently as there is no contracted reimbursement rate. Insurance companies will typically reimburse either a set amount (for example, $45/session, no matter the cost of the session) or a percentage of the session cost (for example, 50% of the amount billed). You are then responsible for paying the difference between what the therapist charges ($100/session, for example), and what the insurance company reimburses (for example, 50%, or $50). At Tidelands I ask that you pay the full fee at the time of service and then submit a Superbill for reimbursement (see below).

Some insurance companies will not reimburse Out-of-Network Providers at all in an effort to control their costs. In this case you are responsible for the full session cost.

Mat Chirman is Out-of-Network or a Non-Contracted Providers for all national insurance companies (Anthem Blue Cross, Blue Shield, Aetna, Magellan, etc.). 

Billing Insurance

If you receive services from me as an Out-of Network Provider I can provide you with what is called a Superbill. A Superbill is simply a bill for the services you have received and paid for that has all of the information that an insurance company will need to consider reimbursing you for those services. You will need to contact your insurance company to find out how to submit a Superbill for reimbursement. Procedures may differ by insurance company.

Please notify me at your first session if you would like me to prepare Superbills for you. Typically I complete Superbills on a monthly basis, but at your advance request I can give them to you more frequently.

What You Should Know

You are responsible for understanding your insurance benefits and what will and will not be covered. Some questions you should ask your insurance provider before starting therapy are as follows:

Do I have mental health benefits?

Are my mental health benefits limited to certain mental illnesses or problems?

How much does my plan pay for a Licensed Marriage and Family Therapist who is an Out-of-Network Provider?

What is my deductible for an Out-of-Network Provider and has it been met?

How many sessions per calendar year does my plan cover?

Is a referral required from my primary care physician?

Is a “prior authorization code” or other approval required before I start therapy?

Other Important Information

Insurance will not pay for missed or late-cancel sessions. In these cases, you will be responsible for the full session fee. A minimum of 24 hours notice of cancelation is required.

If your insurance company requests a report in order to process your claim, you are responsible for payment for the report writing service. I will notify you of this requirement in advance of writing and billing for the report.

Questions?

If you have any questions about insurance or how my billing works, please make sure to ask me at your first appointment!

Links to Insurance Company Patient Web Sites
• Covered California
• The Holman Group