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Insurance

At the moment our practice accepts Blue Cross Blue Shield, Baylor Scott & White Health Plan, Traditional Medicaid, Optum/United Healthcare, CIGNA, CIGNA EAP, Aetna, Aetna EAP, Interface Behavioral Health, Lyra and Modern Health. We recommend confirming that your requested provider is in network before scheduling your first appointment.

What is a Single Case Agreement and How Can I Obtain Approval?

A single case agreement, is an agreement between the provider/practice and the client’s insurance carrier in which the insurance company agrees to a negotiated rate to help you maintain your providers. This usually allows your copay to remain what it typically is for an in network provider and the insurance company eats the other end of the bill. Many insurance companies may not grant it or attempt to force you into utilizing other providers in your network. You are able to list the benefits, hardships it would cause if you had to seek a new clinician, access to in-person services, diversity of the clinician and treatment options offered such as EMDR, Sandtray or play therapy. Sometimes speaking to a supervisor may make increase your likelihood of approval. Single case agreements will not always be accepted or negotiated at a rate equitable to your provider’s private pay rate. To request a single case agreement, clients will ask our front office for single case agreement provider info and we will send you everything you will need before calling your insurance company to request single case agreement requests. If you currently have a high deductible plan, it may not be worth the extra step.

What Are Some Financial Resources Available to Me?

What are some ways in which I can see a therapist out-of-network with my insurance?

We utilize Float, a platform in which FLOAT pays us our cash rates and will do all of your out of network benefits paperwork for you so that you do not have to pay the full amount up front. We will accept CareCredit in the future for behavioral health services, please give us a call if you wish to use CareCredit.

What Does Out-of-Network Billing Mean and What is a Superbill?

“Out-of-network” means providers and facilities either haven't signed a contract with an insurance company or have terminated their contract with an insurance company. Providers who are considered as out-of-network does not agree to your insurance plan terms, agreements or rates and provides services at their own determined private pay rates. The client then submits a superbill to their insurance plan for payments to count towards their out-of-network benefits and/or for reimbursement by their insurance plan.

A Superbill is an itemized list of all services provided to a client. The Superbill will also contain additional information about the patient visit including practice information, CPT codes, ICD-10 codes, referring doctors and more. If you intend to submit this document to your insurance panel for reimbursement, please let us know so that we can provide a diagnosis. Clients are responsible for submitting this superbill directly to their insurance company.

The provider must be an unrestricted licensed individual for these options LPC, LMFT or LCSW

How Does Out-Of-Network Reimbursement Work?

Check your out-of-network deductible, the amount you have to spend before your insurance plan reimburses you.  You will pay the providers full fee at the time of service and submit the superbill to your insurance plan for direct reimbursement to you. Your reimbursement rate is dependent upon your plan, so you will want to ask.

Example: 
Therapist charges $100
Client out-of-network deductible is $1000 with a reimbursement rate of 70%

Client has me their out of network maximum of $1000 so the client pays $100 at the session and insurance reimburses them $70 in cash, check or direct deposit.

DO YOU OFFER SLIDING SCALE?

What is sliding scale?
Sliding scale is where a provider offers lower rates for families with financial limitations. It allows for clients to not have to choose between mental health services or living expenses.

 

Why is it important?
Crave Counseling offers sliding scale because we are committed to ensure access for all.

 

How do I qualify?
Clients who have high deductible plans and/or have income that falls below the federal poverty line. If you would like to determine eligibility please see slide scale table below.

 

What will disqualify me?
Participants who have insurance but would like to still bill out of network for benefits would not qualify because we are still in network with some panels and if a claim is submitted to the insurance company by the client, insurance will accept it as in network and insurance will be billed at our cash rate.

 

What if I have insurance?
This option is really good for clients who have high deductible plans and can’t afford their out of pocket costs based on insurance requirements. Most clients who decide to use their insurance will have to pay the insurances discounted rates and providers are not allowed to waive it because it would be considered insurance fraud. So if you choose to use the sliding scale options, clients are still not eligible to bill their insurance because we are still in network with some panels. Clients who choose not to bill their insurance and choose the slide scale option do not need a diagnostic code.

What are future plans of Crave Counseling when it comes to insurance and sliding scale?
As mentioned on some of the other pages on our website, our plan is to switch to a 100% cash based practice to better support clients as we often have clawbacks, have to fight insurance regarding payments and are forced to track clients down for payments that were given to us by insurance and later taken back leaving clients with huge outstanding balances. About 80% of our clients are underinsured and/or have high deductible plans leaving them with giant bills anyway and our main goal is healthcare equity. We will do our best to remain in network with CIGNA and Aetna. We are transitioning away from BCBS and UnitedHealthcare/Optum in the coming moths. If you have out of network benefits and would like to bill your insurance or request a single case agreement, we will bill at the rate of above 200% for clients seeking to bill their out of network benefits.

No client will be turned away due to their inability to pay and we have slide-scale options available for all. Sliding scale slots are limited but we will try to do our best efforts to accommodate your family. Please use the chart to determine where your rates would fall and which providers would be the best fit for your financial status.

 

Please see example of how to read the chart below:

I am a mother of 3, wants to see an LPC and I make $27,000 a year, you would go down to the family size of 4 and see that your family falls below below the 2023 federal poverty line. You would pay $75 for sessions. If $75 is too much then you have the option to see a practicum student for $35 a session, an associate at $60 per session or an LPC or LMFT at $75 a session.

 

How do I verify my income to be eligible for slide scale?
Clients will be able to complete a sliding scale application and submit income verification which is a copy of:

  • Previous year’s 1040 tax form

  • Two months of pay stubs

  • 2 unemployment stubs

  • Copy of Social Security or Disability Check

  • Letter from an employer that states your salary or wages

  • Profit Loss Statement (those self-employed)

What if I don't want to provider verification of income?

If a client does not want to verify income, then the family will be disqualified from being eligible for sliding scale because we are required to collect certain details for reporting purposes.

What if I can't afford the full cash rate?

No one will be denied access to services due to inability to pay and there is a discounted/sliding fee schedule available based on family size and income.

Round Rock Sliding Scale Table
federal poverty line

Family Size

1

2

3

4

5

6

7

8

Provider Type

Intern

LPC Associates or PLPC

 

LPC & LMFT Only

Cancellation Rates

At or Below 100%

$14,580

$19,720

$24,860

$30,000

$35,140

$40,280

$45,420

$50,560

Rates

$35/ind 

$40/couples-fam

$60/ind

$65/couples-fam

$75/ind

$85/couples-fam

Full Session Fee- LPC/LMFT

Full Session Fee- LPC-Associate/PLPC

Full Session Fee- Intern

101-150%

$14,581- $21,870

$19,721- $29,580

$24,861- $37,290

$30,001- $45,000

$35,141- $52,710

$40,281- $60,420

$45,421- $68,130

$50,561- $75,840

Rates

$40/ind
$45/couples-fam


$70/ind
$75/couples-fam


$90/ind
$100/couples-fam

Full Session Fee- LPC/LMFT

Full Session Fee- LPC-Associate/PLPC

Full Session Fee- Intern

151-200%

$21,871 - $29,160

$29,581- $39,440

$37,291- $49,720

$45,001- $60,000

$52,711- $70,280

$60,421- $80,560

$68,131- $90,840

$75,841- $101,120

Rates

$45/ind
$50/couples-fam


$80/ind
$85/couples-fam


$100/ind
$110/couples-fam

Full Session Fee- LPC/LMFT

$75- LPC-Associate/PLPC

Full Session Fee Intern

Above 200%

Read More

$29,161 or more

$39,441 or more

$49,721 or more

$60,001 or more

$70,281 or more

$80,561 or more

$90,841 or more

$101,121 or more

Rates

$50/ind
$60/couples-fam

 

$100/ind
$120/couples-fam

 

$150/ind
$170/couples-fam

$120- LPC/LMFT

$75- LPC-Associate/PLPC

Full Session Fee Intern

Family Size

1

2

3

4

5

6

7

8

Provider Type

Intern

 

LPC Associates or PLPC

 

LPC & LMFT Only

Cancellation Rates

At or Below 100%

$14,580

$19,720

$24,860

$30,000

$35,140

$40,280

$45,420

$50,560

Rates

$35/ind 

$40/couples-fam

$60/ind

$65/couples-fam

$70/ind

$75/couples-fam

Full Session Fee- LPC/LMFT

Full Session Fee- LPC-Associate/PLPC

Full Session Fee- Intern

101-150%

$14,581- $21,870

$19,721- $29,580

$24,861- $37,290

$30,001- $45,000

$35,141- $52,710

$40,281- $60,420

$45,421- $68,130

$50,561- $75,840

Rates

$40/ind
$45/couples-fam


$70/ind
$75/couples-fam


$80/ind
$85/couples-fam

Full Session Fee- LPC/LMFT

Full Session Fee- LPC-Associate/PLPC

Full Session Fee- Intern

151-200%

$21,871 - $29,160

$29,581- $39,440

$37,291- $49,720

$45,001- $60,000

$52,711- $70,280

$60,421- $80,560

$68,131- $90,840

$75,841- $101,120

Rates

$45/ind
$50/couples-fam


$80/ind
$85/couples-fam


$90/ind
$95/couples-fam

Full Session Fee- LPC/LMFT

$75- LPC-Associate/PLPC

Full Session Fee- Intern

Above 200%

Read More

$29,161 or more

$39,441 or more

$49,721 or more

$60,001 or more

$70,281 or more

$80,561 or more

$90,841 or more

$101,121 or more

Rates

$50/ind
$60/couples-fam

 

$100/ind
$120/couples-fam

 

$150/ind
$170/couples-fam

$120- LPC/LMFT

$75- LPC-Associate/PLPC

Full Session Fee- Intern

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