The charge for same-day cancellations is 100% of your session fee. The charge for failure to keep an appointment without 24-hour notification is 100% of your session fee. To avoid this fee, please cancel your appointment at least 24 hours before the appointment day.

Veterans can get a VA referral for counseling/therapy to schedule an appointment with us

Insurance and other payment options

Why Mental Health Professionals Stop Accepting Insurance

Many mental health professionals have stopped accepting insurance for payment and have moved to provide services only on a self-pay basis. There are many valid reasons for this. Insurance companies require that we assign you a “Diagnosis Code”, which becomes a part of your permanent medical record.

Some people are uncomfortable with this and the potential impact it could have on them in the future. Insurance companies often require information to be sent to them about what happens in sessions to justify payment and can put stipulations on how many sessions they will allow a client to come before they will no longer pay for sessions.

They also require lengthy billing processes and can be slow to reimburse providers for work they have already done. Due to these stipulations, and the challenges that often come for providers regarding receiving payment from insurance companies, we prefer to work with clients on a self-pay basis only due to the reasons stated above.

Finding a therapist who takes your insurance can be nearly impossible. Here's why.

Click here for 7 minute listen

Although federal law requires insurers to provide the same access to mental and physical health care, these companies have been caught, time and again, shortchanging customers with mental illness — restricting coverage and delaying or denying treatment.

There are nowhere near enough available therapists in insurance networks to serve all of the people seeking care. And although almost all Americans are insured, about half of people with mental illness are unable to access treatment.

It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.

All the while, mental health providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to hold music, and sending faxes into the abyss.

Insurers frequently interfere with patient care. In addition to cutting off therapy, they are pressuring providers to cap the length of their sessions to 45 minutes, even when the patients require more time. Therapists told us that they have seen their patients sink deeper into depression, suffer worsening panic attacks, and wind up in emergency rooms after insurers refused to cover treatment.

August 25, 20247:00 AM ET

Heard on Weekend Edition Sunday

By Annie Waldman, Maya Miller, Max Blau, Duaa Eldeib, Rhitu Chatterjee

https://www.npr.org/sections/shots-health-news/2024/08/24/nx-s1-5028551/insurance-therapy-therapist-mental-health-coverage?fbclid=IwY2xjawE-o6lleHRuA2FlbQIxMQABHS_F-eUYZRMWcs0843Avw18sYnGbnMgsLrbw0T0pDXhtA3mtIEH10m4FfQ_aem_mQb_texCXnk07v2kvioSig

Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Private Pay:

We welcome private pay clients who either do not have insurance or do not want to use their insurance. You will receive an invoice after each session to be paid upon receipt. We accept payment via cash, check, debit or credit card, FSA card, Venmo, Zelle, etc., and also via a PayPal invoice that you will receive after each session via email to be paid upon receipt.

Health Savings Account (HSA):

Clients may choose to pay for services through their eligible Health Savings Account (HSA).

Out of Network (OON):

Summerville Women’s Mental Health Services (SWMHS) is considered Out-Of-Network (OON) by some insurance companies, however, we can provide a Super Bill (a receipt for services) for you to submit to your insurance company for possible reimbursement. As an Out-Of-Network (OON) provider for insurance companies, your insurance company often reimburses services at rates that differ based on your benefits package or insurance plan. Please get in touch with your insurer or visit their website to verify your level of mental health coverage. We are happy to provide you with a detailed statement after each paid session, which you may submit to your insurance company for reimbursement. Payment is expected directly to us after each session first.

Please contact your insurance company directly to determine your Out-Of-Network (OON) coverage for outpatient therapy. Below are helpful questions to ask your insurance provider to determine your Out-Of-Network (OON) benefits:

Do I need a referral from my primary care physician to see a mental health professional?
Do I need pre-approval from my insurance company before I can see a mental health professional?
What is my coverage for out-of-network providers?
What is my yearly maximum benefit (dollar amount or number of visits)?
Is there a deductible?

If you would like to try and access your “Out of Network” insurance benefits, your therapist can provide you with a form (called a Superbill) which you can submit to your insurance company to try and receive reimbursement. We have many clients who can get at least partial reimbursement for the cost of sessions this way. If you want to try this, we recommend calling the number on the back of your insurance card to find out what your specific plan’s policy is for out-of-network mental health providers. Word of warning though: to do this, we do have to assign you a “Diagnosis Code”, as required by insurance, which becomes part of your permanent medical record.

Mentaya:

We've partnered with Mentaya, a service that streamlines getting reimbursed for your therapy sessions through out-of-network benefits. Mentaya is perfect if you:

• Have out-of-network benefits

• Feel overwhelmed by superbills and insurance

• Have submitted superbills but failed to get any reimbursement

• Simply want to skip the hassle of paperwork!

Here's how it works:

1. Sign up for Mentaya: https://mentaya.co/inviteclient/Oj86YuJfQr4m49BWKUM0

2. Our practice will enter your sessions into the platform.

3. Mentaya submits the claim and handles any insurance follow-up.

4. You get reimbursed by insurance!

Mentaya charges a 5% fee per claim, which includes handling any paperwork required, dealing with denials, and calling insurance companies. It's risk-free: They guarantee claims are successfully submitted, or a full refund of their fees.

Insurance:

SonderMind: We accept clients virtually or in person via SonderMind with the following insurance in South Carolina:

Aetna

Aetna Allied Benefit System

Aetna Gravie

Aetna Meritain

Aetna WebTPA

Decent Health

Optum VA

Optum/United-EAP

Prime Health

United All Savers

United GEHA/Shared Services

United Healthcare Golden Rule

United Oxford

United Student Resources

United Surest

United UMR

Unity

Velocity

Find me on SonderMind at

https://www.sondermind.com/providers/45euu0mo/xiomara-sosa

Talkspace: We accept clients virtually via Talkspace with the following insurance in South Carolina:

Aetna

Beacon/Carelon

Cigna

Medicare

Optum

Premera

Regence

TRICARE East/Humana Military

Find me on Talkspace at

https://www.talkspace.com/therapists/profile/xiomara-sosa-3641531

CHAMPA

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a VA health benefits program. CHAMPVA is for spouses, dependents, and survivors of Veterans who meet certain service-connected disability requirements.

CHAMPVA eligibility, benefits, and how to apply

How to file a CHAMPVA claim

In most cases, you don’t need to get authorization (approval) before you get care through CHAMPVA. But you do need approval for certain types of care.

To get approval for mental health care, alcohol use, or substance use:

Call us at 800-424-4018. If you live outside the U.S., call us at +1-800-424-4685.

Or mail a letter to this address:

Behavioral Health
CHAMPVA
PO Box 500
Spring City, PA 19475

There’s no specific network of CHAMPVA providers.

When you find a new provider, ask if they “accept assignment” from CHAMPVA. This means they agree to accept CHAMPVA insurance and to charge only the allowable amount.

If you go to a provider who doesn’t accept CHAMPVA, we may still cover some of the cost. You’ll need to pay the provider out of pocket and then file a claim for reimbursement. But we’ll only pay our allowable amount. You’ll need to pay any costs above that amount.

Call us at 800-733-8387 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 7:30 p.m. ET.

You can also contact us online through Ask VA.

Getting Care Through CHAMPVA

fees and insurance

fees

Counseling/Therapy Services

Clinical Consultation services

Clinical Supervision services

CANCELLATION POLICY

Veterans can get a VA referral for counseling/therapy to schedule an appointment with us

Insurance and other payment options

Summerville Women’s mental health services