Frequently Asked Questions
Can you explain "integrated therapy"?
It is often helpful to have a couple's therapist plus a separate individual therapist to support each partner. That way each person can focus on growing individually so he/she can show up in the relationship in a healthy way. This set up works best when the therapists are in the same group and can coordinate care.
Do I have to get a diagnosis?
Most of our clients do NOT seek to receive a diagnosis, nor do we find much benefit in providing one. It is much more effective to treat whatever unique characteristics which present themselves and avoid the negative effects of labeling and having a fixed mindset.
Autism Spectrum Quotient (AQ) Test (a result of 33-50 indicates the possibility of Asperger’s)
Empathy Quotient (EQ) Test (a result of 30 or above indicates the possible absence of Asperger’s)
Ritvo Autism & Asperger Diagnostic Scale- RAADS-14. (scores of 14 and above are indicative of possible Asperger's).
Discuss your developmental history
Discuss your development of peer relationships and friendships and the quality of attachment to family members
Make behavioral observations including your social and emotional presentation
Observe your self-awareness, perspective-taking and level of insight into social and behavioral issues
Discuss your ability to understand another person’s feelings, intentions and beliefs
Ask for your self-report of certain symptoms
Meet with a friend or family member who can provide additional perspective
Assess for related issues such as obsessive-compulsive tendencies, general anxiety and depression.
How does insurance work?
We have tried to cover answers to all the insurance questions that we get from clients. If we missed something, please do not hesitate to ask your therapist.
We have chosen to remain an “out-of-network” provider for all insurance companies. In our experience, this allows us to provide a higher quality of care, independent from insurance-based rules or decisions. Accordingly, full payment is due from you at the beginning of each therapy session. We accept payment by cash, check or credit card.
It is your choice whether you would like to apply for insurance reimbursement or not. Although we do not accept direct payment from insurance companies, we provide a “super-bill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the super-bill to your insurance company for reimbursement. Please note that we do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.
DIAGNOSIS IN COUPLES THERAPY:
For couples therapy, most insurance companies will reimburse for therapy involving two people if one person has been given a diagnosis. We should have a discussion to make sure the appropriate partner is provided with a diagnosis. The diagnosis often is not one of Autism Spectrum Disorder but rather one that is less stigmatizing such as Adjustment Disorder. Your therapist will be able to discuss this with you in advance of making an official diagnosis.
QUESTIONS TO ASK YOUR INSURANCE PROVIDER:
To find out more about your coverage, call your provider, get the name of the person you are speaking to, and ask the following questions:
- Does my policy cover out-of-network outpatient psychotherapy?
- CPT CODES: If yes, what is the reimbursement for out-of-network psychotherapy services for the following CPT codes: 90834, 90837, 90847. What is the reimbursement rate for telehealth CPT codes, 90834-95, 90837-95, and 90847-95? Your insurance company should understand what a “CPT code” is, and whether they reimburse for these specific codes.
- Is there a maximum number of psychotherapy sessions for which they will provide reimbursement?
- DIAGNOSIS CODES: Will the insurance company reimburse for the diagnoses which you have discussed with your therapist?
- % REIMBURSED: If your insurance company reimburses a percentage of the cost, what is that percentage, and what is the maximum cost per session they are allowing?
For instance, they may reimburse 70% of a psychotherapy session (CPT code 90837), but assume that the maximum rate of the psychotherapy session is only $120 (instead of my actual rate). This would mean the client would be reimbursed $84 per session. Another insurance company, however, may only reimburse 50%, but allow a $250 hourly rate, meaning that the client would be reimbursed $125 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.
- Is a doctor’s referral required and/or is pre-authorization required? What is the name and number of the person to be contacted for pre-authorization?
- DEDUCTIBLE: Is there a deductible and how much is it? Is it a yearly deductible? How much of the deductible do I have left over to meet?
- ADMINISTRATIVE: What is the address of the office where I should send my claims? To whose attention is the claim to be sent?
HSA AND FSA ACCOUNTS:
Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.
We understand that financial concerns may lead you to use an in-network provider. Please be aware that there are local non-profit agencies that provide low-cost counseling services.
What's my first step?
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