Close up of rates and insurance paperwork on table

Rates & Insurance

The Lukin Center for Psychotherapy is an Out-of-Network Mental Health Provider

What does that mean for you?

Most insurance providers offer in-network therapy options, but due to caseload requirements, reimbursements, and loads of red tape, an in-network provider simply does not have the freedom to put the patient (you) first. An out-of-network provider like us might mean some out of pocket cost, but you’ll receive personalized treatment, tailored to your needs, from a highly trained expert who is dedicated to helping you reach your goals.

7 Reasons to Go Out-of-Network for Mental Health Treatment

1. More treatment options.

Looking outside of your insurance carrier’s “in network” list means you’re more likely to find a professional with more training, who spends a lot of time on extra education and credentials in their area of specialty. You’ll also find a clinician who can give you more dedicated attention, as they’re likely less burdened by the heavy workload and red tape that comes with in-network requirements.

2. Start treatment sooner, and on your schedule.

You might wait weeks or even months for an appointment with an in-network provider. An out-of-network provider will be able to see you sooner, and will have the flexibility to book an appointment on a day and time that’s convenient for you.

3. Your insurance will probably cover most of the cost.

Most insurance plans will typically cover about 70% of the cost of treatment with an out-of-network provider after your deductible is met.

4. Treatment counts toward your deductible.

Psychological services are health services, so out-of-network treatment costs should combine under the same deductible (for most plans).

5. We’ll help you with reimbursements.

We’ll be happy to provide all of the documentation you need to file a reimbursement claim with your insurance provider, or you can download one of many apps designed to help you file.

6. Treatment has an end date.

If you do have to pay a bit out of pocket, it won’t be for long. At Lukin Center, we provide evidence-based treatment, and that means that treatment is shorter in length than more traditional approaches. You and your therapist will decide the appropriate length of treatment based on your goals, not the insurance company’s guidelines.

7. Mental health is the best investment you can make.

While in-network options can seem attractive based solely on out-of-pocket cost, it’s more important to find the right therapist, with the right credentials, who can dedicate the time and attention to help you reach your goals. Nothing is more important than your mental health, and investing in proven, professional treatment is a worthwhile investment, every time.

In-Network Provider Vs Out-Of-Network Provider

 Out of NetworkIn Network
Treatment Quality✅ Lighter caseload — more time to focus on patients individually.⛔ Heavier caseload — less time for individualized attention
Time✅ Patient-oriented approach⛔ Time-sensitive approach
Cost⛔ 70% is reimbursed once deductible is met.✅ $20 to $30 co-pay
Wait Time for Appointments✅ Short wait times (usually within a few days)⛔ Potentially very long waits (weeks to months)
Continuing Education✅ Spends more time pursuing new training and certifications.⛔ Spends less time learning new treatment approaches.

How do I find out if my insurance plan has out-of-network coverage?

It’s important to make an informed decision before getting started with counseling.

Call your insurance provider and ask:

  • Do I have out-of-network mental health benefits?
  • What is my out-of-network deductible? Does that include medical? Have I met it?
  • Are out-of-network services by a licensed clinical psychologist covered?
  • What is my co-insurance for out-of-network care?
  • Is any pre-approval required under any circumstances before obtaining out-of-network mental health services to be reimbursed?
  • If I have out-of-network benefits, will I be reimbursed the full amount I paid or a percentage? What percentage?

Ask about Procedural Codes:

For psychotherapy, ask:

  • Do you cover the procedural codes 90791, 90834, and/or 90837 for individual therapy?
  • Do you cover the procedural codes 90847 and/or 90846 for family therapy?
  • Do I have telehealth coverage for the procedural codes above with the modifier 95 (i.e. 90834-95, 90847-95)
  • What is the maximum allowed amount for the above procedural codes?

For psychiatry, ask:

  • Do you cover procedural codes 90792 and/or 99214?
  • What is the maximum allowed amount for procedural codes 90792 and/or 99214?

For psychological testing, ask:

Psychological testing is not generally covered by insurance. Further details can be provided once you are connected with the neuropsychologist.