FAQ: Insurance & Payment
What insurance do you take?
We are currently considered ‘in network’ for the following insurance providers:
Tricare East/Humana Military (All Plans: Prime & Select)
Blue Cross Blue Shield (BCBS; All Plans/All States)
New Directions Behavioral Health
Unfortunately, we do NOT take any form of MEDICAID at this time.
Please be aware that NOT ALL therapists are in network for ALL insurances listed above!
In the event that we do not have an in-network therapist available for your plan for the services that you are seeking, we will let you know what your options may be following your submission of the New Client Inquiry Form.
What if you do not accept my insurance?
Clients may opt to be ‘self pay’ and pay ‘out of pocket’ for services at a reduced rate. Additionally, if you have the McKay Scholarship or 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.
Do you accept McKay Scholarship or PLSA/'Step Up for Student' funds?
Unfortunately, we are not an approved provider for the McKay Scholarship. However, if you are using your McKay Scholarship funds through another agency or school and have an excess of funds that you wish to apply towards the cost of your services, we are able to submit invoices to this agency or school for reimbursement, if the agency or school permits. If you are interested in applying portions of your scholarship funds to your services at Beacon, please ask the agency or school that is currently receiving your child's McKay Scholarship funds if this is an option for you!
We are an approved provider for the PLSA/'Step Up for Students' scholarship. If you wish to use these funds to pay for all or a portion of your services, please let us know! We do not submit invoices directly to the scholarship for reimbursement. We will bill your insurance first (if you are using a third party payor), and upon receipt of the remittance from your insurance, we will provide you with an invoice for any remaining amount due. Or, if you are not using insurance, following the service provided, you will be given an invoice outlining the payment due. You are responsible for submitting the invoices via the PLSA/'Step Up for Students' web-portal and paying your balance due to Beacon Pediatric Behavioral Health within 30 days of the date of your invoice.
How much do your services cost?
SELF PAY / OUT OF POCKET:
As a multidisciplinary clinic, with a variety of provider types, Self-Pay fees may vary across providers. The list below serves as a general guideline of potential cost for clients that are not using insurance benefits and paying out of pocket instead:
Initial intake appointment: $150 - $250 for the 60-90 minute new client session
Regular therapy sessions: $100 - $150 for 45-60 minute therapy sessions
Gifted testing: $400 (includes a single 1.5 - 2-hour IQ testing session with report sent to you within a week of testing; no review of results/feedback). If parents are interested in a session with the evaluator to discuss the results, the fee for this 30-minute session is $50).
Psychological testing: Anticipated costs for the actual testing sessions cannot be determined until 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, depending on these details, testing cost typically ranges between $400-$1200 (not including the initial intake appointment and feedback session).
Review of assessment results and feedback session: $100 for 45-60 minute appointment (optional for Gifted testing only, $50 for 30-minute appointment)
ABA therapy sessions: Please contact us directly, as cost will vary depending on the number of hours a client receives, amount of supervision a case requires, etc.
To obtain the most accurate information from your insurance company about potential cost, please contact your insurance company!
Not all plans cover behavioral health services! First, please ensure that your plan includes these types of benefits!
If your plan covers behavioral health, your cost will likely consist of a copay, unless your plan has a deductible and/or co-insurance that must be met first. Typically, our services are considered under the ‘specialist’ or the ‘outpatient behavioral health’ category, thus your cost will likely be listed under these sections of your policy explanation.
If you are seeking psychological testing, we apologize, but we are not able to provide clients with details regarding the potential cost of this service. There are many variables that impact cost and it is often impossible to estimate the total amount due as a result. Your cost will completely depend on your insurance plan and coverage, as well as the amount and type of testing being requested, and the amount of time that it takes to administer the measures to your child. Every insurance plan covers services at a different rate and with different rules and limits/exclusions. Costs across plans may range significantly, thus we unfortunately really cannot not know how much a patient may owe until their insurance is billed and the remit is provided back from the insurance company. Additionally, if you are seeking academic testing, most insurance plans do not cover this type of assessment.
We do not bill insurance for out-of-network benefits at this time.
What does my insurance cover?
Every insurance plan is different. Most plans cover only specific diagnoses and billable procedural (CPT) codes, and all insurances require that any service provided must be deemed as 'medically necessary'. 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 below).
Before initiating services, it is essential that you contact your insurance company, as you are ultimately responsible for knowing the details of your coverage and will be responsible for payment of any services that your plan does not reimburse or cover.
For a helpful explanation of various health insurance terms, click here.
What questions should I ask my insurance company about coverage?
The following questions may be beneficial to ask when you contact your insurance company:
Does my plan cover behavioral health services? (e.g., mental health therapy, ABA, psychological testing, etc. depending on the services you are seeking)
What are my individual and family deductible amounts?
How much of the deductibles amounts remain for the year?
Is the deductible applicable to behavioral health appointments? (e.g., Must you meet your deductible first and then there is a copay/coinsurance? Is only a copay/coinsurance applicable without having to meet the deductible? etc.)
What is the copay/co-insurance amount for "outpatient behavioral health" appointments? (Please note, some plans consider behavioral health providers to be ‘Specialists’)
Are there any limitations, exclusions, etc. to behavioral health services?
How are payments processed?
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 here.
Who do I contact with questions about billing?
The billing and administrative team can be reached at 904.366.9868 or via email at BeaconBillingTeam@gmail.com