Although you will need to confirm that we are in network for your particular plan for the service you are seeking, this list may serve as a general guide. Many of our providers are ‘in network’ for the following insurance companies:

• Tricare East/Humana Military (All Plans: Prime & Select)

• Aetna (please be aware that some behavioral health polices with Aetna may be processed through a different vendor for which we are NOT in network with- please contact Aetna before scheduling)

• Mayo/Medica

• Cigna

• Blue Cross Blue Shield (BCBS)

Unfortunately, we do NOT take any form of MEDICAID at this time. We are also out-of-network for the following (list is not all inclusive): Humana (beyond Tricare), United, GEHA, Avmed, Sunshine Health, Wellcare, Molina, AmBetter, Beacon Health Options, Golden Rule, Capital Health, Oscar Insurance, Kaiser Permanente, MetLife)

Please be aware that NOT ALL therapists and NOT all types of service providers are in network for ALL insurances listed above, which may impact availability!

Insurance can be complicated. PLEASE contact your insurance company to ensure that our agency/providers are considered ‘in network’ for your specific plan prior to scheduling!

Clients MUST inform our team IMMEDIATELY if there are ANY changes to your insurance (e.g., change or loss of coverage, addition of secondary plan. etc.).

This is CRITICAL for may reasons—

• Without accurate insurance information, claims will be sent to the insurance on file, which will result in denial and require new submission of claims- this may cause processing of clams to take several months or more, as a result.

• Secondary insurance often causes claim processing to become extremely complicated. Providers are legally required to report to insurance companies if a client has more than one insurance plan. Clients are not able to choose which insurance plan they prefer to use as ‘primary’ or ‘secondary’ (commercial plans are always primary if the other plan is government funded like Tricare or Medicaid; for 2 commercial plans, you need to contact both to find out which is considered primary)

• The provider you are seeing may not be in-network with the new or additional insurance that you have changed to/added. If we are unaware of the changes, claims will be denied and you will be financially responsible for full payment of costs.

• When clients add or change insurances, any services that require pre-authorization MUST get approval by the new insurance plan before services will be covered. If we are not aware of insurance changes/additions and continue to provide services, any claims for which preauthorization was needed but was not in place will be denied (as insurance rarely ‘back-dates’ auths), and you will be financially responsible for full payment of costs.

You may opt to be ‘self pay’ and pay ‘out of pocket’ for services if you are interested in working with one of our providers that is not in network with your insurance. Additionally, if you have the Family Empowerment Scholarship/ McKay Scholarship/ PLSA /'Step Up for Students' Scholarship, these funds may be able to be used to pay for all or portions of your costs. In some circumstances, a payment plan may be arranged; however this will be discussed on a case by case basis.

IF YOU PLAN TO ‘PAY OUT OF POCKET’ (not using health insurance):

'SELF PAY' FEES FOR THERAPY:

- Initial intake appointment: (first appointment) 60-90 minutes, $150-$225

- Regular therapy session: 45-60 minutes, $100-$150

'SELF PAY' FEES FOR PSYCHOLOGICAL EVALUATION/ DIAGNOSTIC TESTING:

*Please visit the Assessment page on our website for more detailed information!

It is difficult to provide you with an exact cost ahead of time, until we know the details of the type of testing that may be needed and therefore the types of tests and amount of time the testing may require. Anticipated costs for the actual testing sessions can be estimated at the conclusion of your new client initial intake appointment, once we have a better understanding of your concerns, diagnostic rule outs, and the tests that may be needed.

With that said, cost typically includes the following:

• Initial intake appointment: (first appointment) 60-90 minutes, $150-$225

• Direct testing, scoring, interpreting, and report compilation: ranges between $500-$1500.·

• Assessment review and results feedback session: 45-60 minutes, $100 - $150

‘SELF-PAY’ FEES FOR GIFTED ASSESSMENTS (insurance does not cover this service):

*Due to the nature of gifted testing, these appointments are charged and scheduled differently from other types of testing. Gifted testing IS NOT covered by health insurance unfortunately, and payment must be made on the day of your appointment.

• The fee for gifted testing is $400.

• If you wish to schedule the optional 30-minute feedback session to review the results with the evaluator, the fee for this brief appointment is $50.

Gifted testing is completed in just 1 session; there is no need for a separate intake. You will be scheduled for one 1.5 hr to 2-hour block of time during which the evaluator will briefly meet with the parent for a few minutes to gather very basic background information and then will administer the IQ test for the remaining portion of the time. After the testing appointment, the measure will be scored, and a report will be written and provided to you via email or mail (depending on your preference) within 1 week. If you wish to schedule a meeting to review the results of the assessment, this can be done as well; however, there will be an additional charge for this brief (30-minute) feedback session.

GOOD FAITH ESTIMATE:

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care 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 healthcare 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, this may be disputed. Make sure to save a copy of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

If you are using your health insurance benefits, patient responsibility will vary dramatically depending on which type of insurance plan you have and the details of your coverage, as well as the type of services you are receiving. If your plan covers behavioral health, your cost will likely consist of a copay, co-insurance, and/or cost-share, unless your plan has a deductible that must be met first. To obtain the most accurate information from your insurance company about potential cost and coverage for behavioral health services, please contact your insurance company!

PLEASE NOTE: We do not bill insurance for out-of-network benefits at this time.

TRICARE CLIENTS:

Cost will depend on whether you are ‘Active Duty’ or not, and whether your plan is ‘Prime’ or ‘Select.’ For Prime Active plans, there is typically $0 patient responsibility; other plans may have a small deductible of several hundred dollars and/or yearly cap as well as a copay or coinsurance (typically ranging between $30-$60 per date of service). Please visit the Tricare Humana website to determine the details of your coverage: https://www.tricare.mil/Costs/Compare For projected 2024 costs for Tricare insurance, please click here.

COMMERCIAL INSURANCE CLIENTS (BCBS, Aetna, Cigna, Mayo/Medica, etc.):

Due to the significant variability in coverage across plans and across services, we are unable to provide you with exact details on projected costs for your specific plan. You MUST contact your insurance plan if you wish to get detailed information regarding potential coverage and cost ahead of time.

Different insurance plans have paid claims in full with $0 patient responsibility, while others have paid $0, with the entire amount going towards the deductible rendering the entire balance due as patient responsibility. Further, some plans cover certain behavioral health services with only a copay, while other services arp y to the deductible. It can be incredibly complicated, which is why we cannot emphasize enough how important it is for clients to understand their benefits and coverage before starting services!

In general, if a deductible does not apply, copays often range from $0-$75 for each date of service (though this will vary based on your plan). If a deductible does apply, you will be responsible for the FULL COST cost of services until your deductible is met (deductible amounts vary widely- anywhere between $250 per year up to $20,000 per year, or more). If a deductible DOES apply, you may expect your cost to be between $100 and $200 for the intake or each therapy ‘hour’; often between $500 and $1800 for testing; ABA costs may be several hundred dollars or more per week..

Please contact your insurance company before your first appointment to ask the questions listed in the section below, “What should I ask my insurance company about my coverage?” as you are responsible for understanding the type of coverage you have and will be responsible for payment of any services not covered by your plan (typically, our services are considered under the ‘specialist’ or the ‘outpatient behavioral health’ category)

If you are seeking educational or academic testing/have concerns related to learning disabilities and/or ADHD, please be aware that any tests that commercial insurance considers primarily for educational purposes (e.g., psychoeducational tests, academic/achievement tests, certain developmental tests, reading batteries, etc.) will typically NOT be covered under your policy. As such, please anticipate that you will likely be responsible for paying out of pocket ($400-$500) for any academic testing you may be seeking, in addition to any copays, co-insurance, and/or deductibles for the portion of testing that is covered by your insurance policy. Please review the details on the Assessment page of our website for more detailed information!

You have the option to ‘opt out’ of using insurance benefits for your services if you wish; we can provide you with the form to do so if you choose to pursue this option.

The following questions may be beneficial to ask when you contact your insurance company:

• Is Beacon covered under my insurance for the service I am seeking?

  o Provider: Beacon Pediatric Behavioral Health

  o Group NPI: 1770838872

  o Directors: Adrienne L. DeSantis King, Ph.D., licensed psychologist (NPI: 1467605493), Parastoo Nabizadeh, Psy.D., licensed psychologist (NPI: 1114226974),

  o Primary Address: 6816 Southpoint Pkwy, Ste 202, Jacksonville, FL 32216

  NOTE: Using the details above will help you to determine if we accept your insurance; however, the availability of specific in-network providers at Beacon for different services may vary.

• Does my plan cover behavioral health services? CPT codes include (but not limited to):

  o Intake 90791; Testing 96130, 96131, 96136, 96137; Consultation/Therapy 90837, 90834, 90832, 90847, 90846; ABA 97153, 97155, 97156, 97151

• Does my plan cover the diagnosis that services are needed for? Common ICD-10 codes include (but not limited to):

  o F84.0 (Autism), F91.9 (Disruptive Disorder), F91.3 (ODD), F90.2 (ADHD), F41.9 (Anxiety), F32.9 (Depression), F43.20 (Adjustment Disorder), F81.0, F81.2, F81.81 (Learning Disorders)

  NOTE: For testing, if evaluation investigates several different diagnoses, including both covered and non-covered

Every insurance plan is different. Most plans cover only specific diagnoses (ICD-10) and billable procedural (CPT) codes, and all insurances require that any service provided must be deemed as 'medically necessary'. If you have questions, we encourage you to contact your insurance company prior to beginning services to ensure that the services you are seeking will be covered (a list of helpful questions is provided above). Common behavioral health CPT codes are provided below (though this list is not all inclusive):

• Initial new client/diagnostic intake: 90791

• Consultation/ counseling/ mental health therapy: 90837, 90834, 90832, 90847, 90846

• Psychological testing: 96130, 96131, 96136, 96137

• ABA: 97151, 97153, 97155, 97156

Patients are responsible for knowing the details of their insurance plan and coverage details, as patients are ultimately responsible for payment of any services that their plan does not reimburse or cover.

Recent changes in the current healthcare market has unfortunately resulted in insurance policies increasingly transferring costs to you, the insured. Additionally, some insurance plans require deductibles, co-insurance, cost-shares, and co-payments in amounts not known to you or us at the time of your visit. You are ultimately responsible for knowing your coverage details and paying the ‘patient responsibility’ portion of your service costs.

Due to these changes, we now require all clients to keep an active credit card securely on file as a convenient method of payment for the portion of services that your insurance does not cover, but for which you are liable. If you have an HSA or FLEX card that has a VISA or Mastercard logo, you may use this type of card in lieu of a credit card, if you wish. For more information on this policy, please click on the FORMS tab in the menu.

The billing and administrative team can be reached at 904.366.9868 or via email at BeaconBillingTeam@gmail.com