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INSURANCE: How it Works

Many potential clients are often seeking to utilize insurance benefits to cover psychotherapy.  It is important to know that, in order for insurance companies to consider payment toward the cost of psychotherapy sessions, a potential client will need to have a clinical diagnosis and treatment plan that addresses those symptoms. The diagnosis and treatment plan help to substantiate what insurance companies call "medical necessity" and with them, they are more likely to consider payment.  

Many problems, issues, and concerns prompt someone to seek professional help, however those problems and experiences do not always align with a clinical disorder.  It is unethical and fraudulent for a clinician to make a diagnosis for the sole purpose of billing insurance.  Avoid a clinician who offers to do so.  Barbash, E. (2017, January 5).  Reasons to Not Use Insurance for Mental Health Treatment.  Tampa Therapy.  

Accepted Insurances

  • Aetna

  • Highmark of Pennsylvania

  • United Behavioral Health

  • Optum Behavioral Health

  • Evernorth Health Services

  • Pennsylvania Medical Assistance 

    • I accept straight Medicaid at this time and am awaiting credentialing ​with various Managed Care Organizations

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No Surprise Act & Good Faith Estimate

The No Surprises Act is part of the Consolidated Appropriations Act of 2021 and is designed to protect clients from receiving unexpected medical bills. The Good Faith Estimate provision of the No Surprises Act is designed to give clients an estimate of how much they’ll be charged for the healthcare services they’ll be receiving, prior to their appointment..  A potential client has a right to receive a Good Faith Estimate if they are uninsured or are not planning to submit a claim to their insurance company for the services they're seeking.  Healthcare providers are required to provide a Good Faith Estimate of charges to every new and continuing client who’s either uninsured or isn’t planning to submit a claim to their insurance for the services they’re seeking. I am contracted with the above insurance companies.  If you do not have insurance with any of those providers, I am considered out of network.  River Rock Counseling, LLC does not accept out of network clients, self-pay, nor offer a sliding fee scale.  The practice limits administrative work, in order to maximize time spent engaging in clinical work and professional development.   

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