Most insurances are required to offer some coverage for mental health. It’s important to determine what your specific plan covers. Each insurance company has multiple plans so you may have different costs than someone else with the same insurance company.

Your coverage will likely be different for in-network or out-of-network providers. In-network providers have an agreement with your insurance company and you will usually pay less to see them. Providers who do not have an agreement with your company are considered out-of-network. You may have some coverage to see them but the costs could be higher and you may have to pay for therapy upfront and submit your bills to the insurance company for partial reimbursement. Some plans have no out-of-network benefits, in which case you would have to pay the entire cost of sessions.

Therapy could be entirely covered by your insurance, however you may have some costs out of pocket. Many insurance plans have a deductible, which is an amount you are required to pay out-of-pocket each year for health care before the insurance kicks in. Deductibles often restart in January, so be careful when you schedule your first appointments of the year as your out-of-pocket costs may have changed.

You may also have copays, (a set amount you pay per service) or be responsible for co-insurance (a percentage of the total cost of the service). For example you could have a $15 copay or 20% coinsurance.

Some employers provide therapy coverage through their EAP (employee assistance program) benefits. In this case you will likely have to get an authorization that will cover a set number of sessions. Ask your employer for more information about this type of coverage.

I am an in-network provider with the following insurances:

• Blue Cross Blue Shield

• Blue Care Network

• Priority Health

• Aetna

You may still have out of pocket costs using these insurances, depending on your specific insurance plan. Please contact your insurance provider for more details on your plan.

You may be able to use other insurances if your plan has coverage for out of network providers.

If you are planning to use insurance we recommend contacting your provider to verify coverage details before your first appointment. Contact your insurance using the phone number on your card, or their website to find information about your plan. Look for “behavioral health” or “outpatient mental health” coverage. Some helpful questions to ask are:

• Do my benefits cover outpatient mental health services?

• Do I have out-of-network coverage if my therapist is not in your network?

• Do my benefits cover telehealth services?

• Do I have a deductible to meet before my benefits start?

• Will I be responsible for a copay or co-insurance for sessions?

• Do I need to get a referral or preauthorization?

• Do I have a limit to the number of outpatient therapy sessions my insurance will cover?

Privacy and confidentiality are very important in therapy and we take this seriously. Therapists are ethically and legally responsible for maintaining your privacy. That means not sharing your records or information, and ensuring privacy in the office.

You can give permission to your therapist to share information. If you use insurance, your therapist will need to share some information with your insurance company for your services to be covered. You may also choose to give your therapist permission to talk to a family member or other supportive person.

There are some instances when a therapist must break confidentiality. These include:

Imminent threat to the client or another person

The therapist has a duty to notify potential victims or law enforcement if a patient expresses a serious, specific, and imminent threat of harm to an identifiable third party.

Therapists may need to share information if a client discloses a plan and intent for suicide. It’s important to feel safe talking to your therapist about self harm issues and suicidal ideation as well as understanding the limits of confidentiality. Please talk to your therapist if this is a concern.

Mandated reporting of suspected child (or vulnerable adult) abuse or neglect

Therapists are mandated reporters who must make a report to the appropriate social service or legal authority if they become aware of suspected abuse or neglect of a child or vulnerable adult

Deciding who to meet with can be one of the hardest parts of starting therapy. Many therapists offer a free consultation, either by phone or video, before you decide to schedule an appointment. This can give you a chance to ask questions and see if you feel it's a good fit for you.

Pay attention to your “gut” since a lot of this comes down to how you feel, if you can connect and trust your therapist. But beyond that, here are some factors to consider:

• Therapeutic approach: Don’t panic! You don’t need to know what therapeutic approach is best for you. But you may have had a previous experience with a particular model or technique or want to try something that was recommended to you. In this case it can help to look for a therapist who uses the specific approach. Some examples are:

  • If you are interested in the mind-body connection and therapies that don’t always focus on talking try someone who uses somatic therapies such as EMDR, breath work or biofeedback. These can be very effective when you are dealing with trauma or PTSD.

  • If you like structure in sessions you may be interested in therapies that use a set of skills to achieve goals such as Dialectical Behavior Therapy (DBT) to increase mindfulness, emotion regulation and interpersonal skills, or Cognitive Behavior Therapy (CBT) to challenge unhelpful thought and behavior patterns.

  • If you want to dig deeper into your past or go “beneath the surface” you can try psychodynamic approaches that use talk therapy to explore and understand past emotions and experiences, including unresolved conflict and unconscious processes.

  • You may want to find a therapist who incorporates culturally relevant practices. This may mean finding a therapist with shared identities or who provides a space to explore the intersectionality of race, ethnicity, and other social identities to help understand and address the roots of distress.

• Educational degree/licensure: You will see various letters after a provider’s name, such as PhD, LP, LMSW, LPC, LMFT, or CAADC. These letters represent their educational degree, professional license, or certifications. You may want to consider the credentials if you are looking for specific service or focus area, such as:

  • Family or couples counseling- A LMFT (licensed marriage and family therapist) will have more training for this.

  • Substance use or addictions- Clinicians can get an additional credential such as CAADC (certified advanced alcohol and drug counselor) to indicate they have training and experience treating substance use disorders.

  • Psychological testing- formal psychological testing and assessments are done by licensed psychologists. This may be helpful if you are looking to get more clarification or diagnosis for conditions such as ADHD, autism spectrum disorder, or learning disabilities.

  • Medications-If you want to get a prescription for psychotropic medications be sure to meet with a psychiatrist (or your primary care doctor). These providers will have degrees such as MD or DO.

Winter Sun is located at 934 N Washington, at the corner of Washington and Kilborn. The office is accessible by car or bus. We also have free off-street parking just steps from the door to the office. If transportation is an issue, you can also choose to meet via telehealth.

Click here for more info about our location.

Before scheduling an intake appointment, it’s often helpful to have a short consultation via phone or video, to go over any logistical questions (scheduling, insurance etc) and to see if it feels like a good fit. There is no charge for this consultation.

If you have questions or would like to schedule a consultation, please contact Sarah by phone, email, or using the web form on the contact page.

Yes.

By law, health care providers are required to provide a good faith estimate of expected charges for items and services to individuals who are uninsured or not planning to use their health insurance to pay for services (private pay clients).

The good faith estimate shows the list of expected charges for items or services from your provider or facility. Because the good faith estimate is based on information known at the time your provider or facility creates the estimate, it won’t include any unknown or unexpected costs that may be added during your treatment.

If you are paying for services directly or using out-of-network benefits, we will provide a good faith estimate of services upon request.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 517-301-5399.