Insurance Providers
In-Network Providers
I am currently in-network with the following insurance companies:
- Highmark
- United Healthcare
- Optum Behavioral Health
- Capital Blue Cross
- Quest Behavioral Health
Being in-network means I have a contract with these insurance companies to provide services at a pre-negotiated rate. This typically results in lower out-of-pocket costs for you.
Out-of-Network Billing
If your insurance is not listed above, I can still work with you. I am able to bill other insurance companies as an out-of-network provider. Many insurance plans offer out-of-network benefits that will reimburse you for a portion of your therapy costs.
Understanding Insurance Terms
What Does “In-Network” Mean?
When a therapist is “in-network” with your insurance, it means they have a contract with your insurance company. Benefits of seeing an in-network provider include:
- Lower copays and coinsurance rates
- Services count toward your in-network deductible
- I bill your insurance directly—less paperwork for you
What Does “Out-of-Network” Mean?
When a therapist is “out-of-network,” they don’t have a contract with your insurance company. This means:
- You may have a separate (often higher) out-of-network deductible
- Your insurance may reimburse you for a percentage of the session cost
- You typically pay the full session fee upfront, then submit for reimbursement
What Is a Deductible?
A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance begins to cover costs. For example, if you have a $500 deductible, you pay the first $500 of covered services yourself. After meeting your deductible, your insurance starts sharing the cost.
Important: Many plans have separate deductibles for in-network and out-of-network services. Your out-of-network deductible is often higher.
What Is a Copay?
A copay is a fixed amount you pay for a covered service after you’ve met your deductible. For example, your plan might require a $30 copay for each therapy session. You pay $30, and your insurance covers the rest.
What Is Coinsurance?
Coinsurance is the percentage of costs you pay after meeting your deductible. For example, if your plan has 20% coinsurance, you pay 20% of the allowed amount for a service, and your insurance pays 80%.
Before Your First Session
I strongly recommend calling your insurance company before your first appointment to understand your specific benefits. Every plan is different, and your insurance company can give you the most accurate information about your coverage.
Questions to Ask Your Insurance Company
When you call the member services number on the back of your insurance card, ask:
- Do I have mental health or behavioral health benefits?
- Is Daniel Wethington, LPC (NPI: 1932757580) in-network with my plan?
- What is my deductible for mental health services? How much have I met?
- What is my copay or coinsurance for outpatient therapy sessions?
- Do I need a referral or prior authorization for therapy?
- Is there a limit on the number of sessions covered per year?
Out-of-Network Reimbursement & Superbills
What Is a Superbill?
A superbill is a detailed receipt that I provide to you after each session. It contains all the information your insurance company needs to process a claim for out-of-network reimbursement, including:
- My name, credentials, and NPI number
- Date of service
- CPT code (the billing code for the type of therapy provided)
- Diagnosis code
- Amount paid
How to Use a Superbill
- Pay for your session at the time of service
- I will provide you with a superbill (monthly or after each session, based on your preference)
- Submit the superbill to your insurance company (often through their website, app, or by mail)
- Your insurance will reimburse you directly based on your out-of-network benefits
Note: Reimbursement amounts vary widely depending on your specific plan. Some plans reimburse 50-80% of the session cost after you meet your deductible, while others may offer limited or no out-of-network benefits.
Private Pay Option
You always have the option to pay for therapy privately without using insurance. Some clients choose this option because:
- They prefer to keep therapy completely confidential (insurance requires a diagnosis on file)
- They don’t have mental health benefits or have a high deductible
- They want more flexibility in the type and length of sessions
If you have questions about rates or payment options, please contact me and I’m happy to discuss what works best for your situation.
Questions?
Insurance can be confusing, and I’m here to help. If you have questions about your coverage or how billing works, don’t hesitate to reach out before scheduling your first appointment. I want you to feel informed and comfortable with the financial aspect of therapy so we can focus on what matters most—your wellbeing.