PSYPACT
WHAT IS PSYPACT?
Currently two of our Licensed Psychologists are PSYPACT members: Dr. Cora Ryan and Dr. Justine Diener O’Leary.
Being a PSYPACT (Psychology Interjurisdictional Compact) member signifies a psychologist’s dedication to breaking down geographical barriers in the provision of mental health services. Active PSYPACT membership allows psychologists to extend their reach beyond state lines and offer their expertise to clients in different states through telepsychology. As a PSYPACT member, a psychologist has undergone a streamlined licensing process, demonstrating their commitment to adhering to high ethical and professional standards. This membership empowers them to provide clients with a wider range of options, making it easier for individuals to access specialized care or find the right therapist for their unique needs. It also emphasizes the psychologist's commitment to maintaining strict confidentiality and privacy standards, ensuring the well-being and trust of their clients as they navigate the complexities of providing effective mental health care across state boundaries.
Click here to see if your state is a PSYPACT participant.
Superbills
A superbill is a detailed invoice that outlines the services you’ve received during your sessions with us. While we do not directly bill insurance companies, providing you with a superbill empowers you to seek potential reimbursement from your insurance provider for an out-of-network claim. It includes essential information such as diagnosis codes, session dates, and the type of services rendered. Keep in mind that reimbursement eligibility varies depending on your insurance company and policy, so we recommend reaching out to your insurance provider to understand your coverage better.
A link to access your superbill will be sent to you at the beginning of each new month, covering all sessions in the previous month. Past superbills can be accessed by logging into the Client Portal and clicking on the Documents page.
Out-of-Network Billing
CONSIDERATIONS FOR OUT-OF-NETWORK CLAIMS:
At Shoreline Mental Health & Performance, the licensed therapists offer superbills for out-of-network claims. No Shoreline Mental Health & Performance therapists are in-network. This means that our therapists have not signed contracts with any insurance company. We have not agreed to their in-network fees nor do we have to submit to the insurance company’s oversight of therapeutic goals, methods, and session limits.
Neither your therapist nor Shoreline Mental Health & Performance has any control over what your insurance company decides to reimburse. You are encouraged to contact your insurance company directly to inquire about out-of-network reimbursement and procedures for submitting superbills. It is ultimately your responsibility to know what your policy’s rules are.
DIAGNOSIS: Do I qualify?
The first consideration for using insurance in healthcare is whether or not you qualify for a diagnosis. Insurance companies operate on the basis of helping to pay for treatment of an illness. This known as the medical model. Most insurance companies honor the illnesses included in the International Classification of Diseases version 10 (better known as the ICD-10). Insurance companies do not pay simply for you to talk with a counselor. They only pay if you have been diagnosed with an illness and the doctor or counselor is treating you with an acceptable, approved treatment.
The ICD-10 contains a whole section on mental illness. Examples include depression, generalized anxiety, stress disorders, and bi-polar disorders. There are many mental illness diagnoses. If you qualify as having the symptoms of one of these, then a Diagnosis can be made for you.
Many people seeking to speak with a counselor do not qualify for a mental illness diagnosis. Ordinary, but stressful life transitions do not qualify. Neither do marriage issues unless one or both partners are distressed to the point of qualifying for a diagnosis. So your counselor, during the intake phase of your work, will be assessing whether your cluster of issues and symptoms qualifies for a diagnosis approved by your insurance company. If your counselor does not think you qualify, then you will not be able to use your insurance for seeing this counselor.
Even if you qualify for a diagnosis, you might prefer not to have it on your medical record. If you are diagnosed with a mental illness and you choose to file or have claims filed with your insurance company, then that diagnosis becomes a part of your medical record. This can be an issue for people seeking security clearances and some life insurance policy applications seek information about mental illness as well as physical issues. Many people do not want a mental illness diagnosis on their record and thus choose not to have claims filed with their insurance company.
Cash Billing
Cash billing is used when you are paying for your counseling services with cash, check, or credit card and are not attempting to file insurance claims. Counselors who are working towards getting licensed and interns are not authorized to file insurance claims. Sometimes licensed therapists do not file claims. You as a client might not want to file insurance claims because you do not want a mental illness diagnosis on your medical record.
When paying cash for services, the billing at Shoreline Mental Health & Performance is simple. You just pay the counselor’s fee for each session conducted. There are no surprises or hidden fees. In some cases where a client expresses financial hardship, a therapist is free to reduce his or her fee to accommodate the hardship. Any reduction of this kind is discussed and agreed to between therapist and client. There are no surprises here. See the “Sample Good Faith Estimate” for more clarification.
“No Surprise Billing”
WHAT IS “NO SURPRISE BILLING”?
Beginning in January 2022, the Public Health Services Act, a new federal law, requires Health Care Providers to provide information about rights and protections to help prevent surprise and unexpected billing. Many have experienced the shock of medical bills following a trip to the ER, surgery, or other medical procedure. Since therapists/counselors are considered Health Care Providers, we are included in this effort to prevent surprise billing.
Keep in mind that overall therapy/counseling costs cannot be estimated like a surgical or other medical procedure. The number of sessions of your work in counseling depends on many factors to be evaluated collaboratively between you and your therapist. The best we can do is to inform you of session fees and help educate about possible insurance benefits.
“Good Faith Estimate”
The Staff at Shoreline Mental Health & Performance will clarify the session fee during your intake appointment. As part of your digital intake paperwork completed before the first appointment, you will be provided with a written estimate that will have information about SMHP and your therapist and a clear statement of the fee and any hardship fee reductions. This estimate is not a contract. You may choose to not see the therapist or switch to another therapist at any time.
You will decide whether or not to file claims with your insurance company. We make no promise of any coverage from your insurance company, and you are responsible for any of the fees they do not pay.
Sliding Fee Scale
To better serve the mental health needs of our community, Shoreline Mental Health and Performance offers an income based sliding fee scale for individual therapy sessions. The sliding scale is available to those who cannot afford the full fee rate of $150/session. In order to be eligible for the sliding scale, you must complete an application, including income information and an explanation of why you cannot pay the full fee. Although in most cases the sliding scale is offered on an honor system, we may occasionally ask for you to verify your income (with a paystub or financial statement).
Sliding scale rates must be agreed upon and signed by both the client and the provider. Sliding scale rates are approved for a duration of 6 months at a time. If at any point during that time your income situation changes, please communicate this to your therapist. After your rate expires, you will default back to the full fee unless you re-apply for the sliding scale and are approved. Generally, there is a limit to how many times a sliding scale will be approved, and you can expect to eventually default to the full fee. For this reason, we ask that you consider sliding scale a benefit that is intended to help you bridge a time of financial hardship, rather than a permanent change in your fee.
2024 SLIDING FEE SCALE
Household Annual Income Reduced Rate (45 min individual therapy session)
<$15,000 $60
$15,000-$25,000 $80
$25,000-$40,000 $100
$40,000-$50,000 $120
$50,000-$60,000 $130
>$60000 $150
2024 SLIDING FEE SCALE POLICIES
Fees are as of January 1, 2024 and are adjusted periodically.
Sliding Fee Scale Agreement is valid and will remain in effect for six months from the date signed by client and therapist.
Fees above are based on regular 45-50 minute individual therapy sessions and will be adjusted and documented below if 25-30 minute sessions are to be provided.
Extended sessions (beyond 53 minutes) are charged at the regular rate of $40/15 minutes. No-show or late canceled appointment will be charged at agreed upon session rate.
Other extenuating circumstances regarding ability to pay (e.g. childcare, high medical bills, etc.) can be documented below and taken into account when agreeing upon fee.
Fee reductions do not apply to intake session.
Your Rights
Though we would love to help with your counseling needs, you are not required to see our therapists. You have freedom to seek in-network therapists through your insurance company if you want.
Though SMHP does not provide billed emergency services, you should be aware that agencies, hospitals, or providers who do provide emergency services are no longer allowed to collect fees beyond in-network rates from you.
If you think you have been wrongly billed at Shoreline Mental Health & Performance, contact Cora Ryan at 910-406-1027. We will be happy to listen and resolve the issue. You can also visit www.CMs.gov/nosurprises/consumers for information about your rights under Federal Law. If you believe you have no gotten resolution with the Shoreline Mental Health & Performance administration, you can call 800-985-3059 for information and to make a complaint. We certainly hope to avoid that and will work with you to get the issue resolved.