Paying for Therapy

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Understanding how to pay for therapy is one of the most commonly cited barriers for families seeking support. We have done our best to provide as much information to you as possible, and if you have a question that isn’t answered here, you can contact us at hello@middletoncounseling.com.

As a courtesy to our clients, we submit claims to most insurance companies.

How much Will My Insurance Cover?

If you have a health insurance benefits policy, it may provide some coverage for mental health treatment when a covered licensed professional provides such treatment. As a courtesy to our clients, Middleton Counseling may provide assistance to facilitate your receipt of the benefits to which you are entitled, including completing insurance forms as appropriate.

It is ultimately your responsibility to understand your covered benefits for mental health services through your health insurance policy. The client, not the insurance company, is responsible for the full payment of fees.

You always have the right to pay for counseling services yourself if you prefer to avoid involving your insurer. If you choose to pay out of pocket, we will give you a “Good Faith Estimate” explaining how much your healthcare at Middleton Counseling will cost.

Some health care plans such as HMOs or PPOs may require advance authorization before providing reimbursement for mental health services. It may be necessary to seek additional approval after a certain number of sessions or for certain types of treatment. This is the clients responsibility.

Insurance benefits can help make therapy affordable, but new clients sometimes find the process confusing or intimidating. Here’s a handy guide to using your benefits:

InsuranceGuide.pdf

In-Network Billing:

We are in-network with most insurance companies and accept the contracted rate. This means that your insurance pays us directly, and you are responsible to pay only your copay, coinsurance, or deductible just as you would at your physicians office.

Out-of-Network Billing:

We provide courtesy billing for insurances that your provider may not be in-network with. This means that you pay us the full fee on the day of your session, we submit an insurance claim on your behalf, and your insurance provider mails you a check to reimburse you for their portion of the session fee. If we are unable to bill them directly, we can provide you with an itemized receipt called a “superbill” to submit directly to your insurance for reimbursement.

EAP (Employment Assistant Plans) Benefits:

Our licensed therapists may accept EAP benefits for new clients. To use this benefit, you must contact your EAP directly and request a referral to our practice. We do not retroactively accept EAP payment for services that have already been provided.

Intern Sessions:

We offer $35 sessions through our graduate student internship program. Graduate student therapists at our practice are working on their master’s degree in a mental health discipline and have completed master’s level coursework in counseling skills, theories, and practice. All therapy interns work under the direct supervision of one of our independently licensed therapists. This service is available only when we have an intern working in our practice and is dependent on their discipline.

Payment Policies

We require a valid credit, debit, FSA or HSA card on file in order to schedule sessions. Your card on file will be charged automatically for your portion of your session fee.

Missed Appointment Policy:

We, at Middleton Counseling, want your counseling experience to be positive and helpful. Counseling is most effective when appointments are kept consistently. We pledge to meet with you for your appointment in a timely manner and we expect you to make all reasonable efforts to attend your appointments on time. When you schedule your appointment, we mutually agreed to meet with each other. If you must cancel or change your appointment, we require that you contact your counselor at least 48 hours in advance. We always give you the opportunity to see your clinician via telehealth.

Late cancelations: (canceling less than 48 hours of your appointment). If you cancel less than 48 hours in advance, you will be charged $50.

No shows: (not calling or not showing up for your appointment). If you have a no-show, then you will be charged $75.

Cancelations: (Calling at least 48 hours in advance of your appointment.) If you have 3 cancelations within a 6-month period, we will assume this isn’t the best time for counseling and your counselor will discuss with you how to move forward.

In the event you must cancel or reschedule an appointment, please contact your counselor by calling 208-965-4502 and pressing their extension.

What is the No Surprises Act?

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental healthcare will cost if you are paying out of pocket and not using insurance.

Under the law, effective January 1, 2022, Healthcare Providers are required to give patients who don’t have insurance, or who are not using insurance, an estimate of the expected charges for medical services, which include mental health care.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services which includes mental health care.

You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to have a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a good faith estimate, visit

http://www.cms.gov/nosurprises/consumers or call our office at 208-965-4502.