Rates
- $250 per Initial Evaluation/ Assessment Intake
- $160 per 50 Minute Individual, Couples or Family Session
- $425 Per Specialized Evaluation/ Assessment Intake
- $1200 per Immigration and Mental Health Evaluation for Standard Return Time
- $275 per Psychiatric Emotional Support and Service Animal Evaluation and Letter
- Additional fees may apply for additional services outside the services described above.
Payment
We Accept the Private Healthcare Insurance Plans for Individual, Family, or Couples Sessions Only:
How to Pay: All Insurance Co-Pays will be billed by a third party electronically at the end of the Individual, Family or Couples therapy session. (We do not accept any State Funded Medicaid Plans.)
For all other services, we accept cash payments electronically though a credit card processor. We accept all major credit cards including Visa, MasterCard, American Express and Discover.
We also accept Health Savings Accounts (HSA).
PLEASE NOTE: All Credit Card payments will be assessed a 4% credit card processing fee.
We have a Fee Less option. We Also Accept Cashapp, Venmo and Zelle Pay by special arrangements only, to avoid an additional 4% transaction fee.
All services are billed and paid at the beginning and prior to starting a service.
When using insurance, insurance verification and eligibility will be made at the time of booking an appointment, by phone. All private insurance copays will be billed after the session has been completed by our third-party biller. All clients will be emailed invoices to pay their copays electronically.
- Aetna
- Cigna
- Optum
- United Healthcare
- United Healthcare Shared Services (UHSS)
- GEHA – United Healthcare Shared Services (UHSS)
- Oscar
- Harvard Pilgrim
- Oxford
- UHC Student Resources
- UMR
- All Savers (UHC)
- Health Plans Inc
- Bind
Cancellation Policy
At least 24 hours notice of cancellation is expected. If you are unable to give me 24 hours advance notice you will be charged $50.
This cancellation policy is standard in the medical and mental health fields and will be strictly enforced. The only time I will waive this fee is in the event of serious or contagious illness or emergency.
No-shows/Arriving Late Policy
Anyone who either forgets or consciously chooses to forget their appointment for whatever reason will be considered a “no-show”. They will be charged the $75 fee for their “missed” appointment.
Appointment times have been arranged specifically for you. If you arrive late, your session may be shortened in order to accommodate others whose appointments follow yours.
Insurance
Center of Inner Transformations is a private, alternative specialty wellness treatment agency. We are out of network with several private insurance companies. This means that we do not bill those insurance companies for all of our services, and also do not accept health plans outside of those health plans listed above.
If you have a private health insurance plan that we do not accept, you may still be covered for a 70% reimbursement through your plans out of network benefits for outpatient mental health services.
Traditional services may be eligible for reimbursement through your out-of-network, outpatient mental health benefits. Health insurance plans and benefits vary. If you are interested in using your out of network health insurance plan benefits to obtain services, please call your insurance provider to verify and confirm your reimbursement for out-of-network psychotherapy/counseling services. (See below for questions to ask your insurance company). We provide assistance with getting reimbursed for your traditional services by providing you a superbill, or bill/receipt of services to seek your reimbursement or also to meet your deductible.
All services would be paid at the start of the session by the client. Clients will receive reimbursement from their private health plans based on their out of network benefits.
Reasons to Pay Privately or “Out of Pocket”
Many clients choose not to involve insurance companies in their mental health care. Their psychotherapy/counseling is not limited by the diagnosis, treatment plan or session limits that health insurance companies dictate. Insurance companies often limit the number of sessions and even the type of therapy. Many insurance companies do not cover couples/relational or family therapy.
To have therapy services covered under insurance, a mental health diagnosis must be made. This then becomes a part of your permanent health care record. This may lead to limitations such as denial for quality life insurance or health insurance later on. Additionally, since a mental health diagnosis must be made to obtain reimbursement, the insurance company has to know a lot of information about you to be covered. The insurance company can review all of your records at their discretion.
By paying privately or out of pocket, we can assure private pay clients of the highest degree of privacy, flexibility and control of their mental health record allowed by New Jersey State law, since our records are exempt from insurance reporting and random compliance audits. Our work is off record, confidential, individualized and provided at the highest care possible.
In addition, many insurance companies require a deductible to be met before they start paying, so you may be paying out of pocket anyway.
We will work collaboratively to decide how often to attend therapy and you decide what you want to focus on. You have the control, not the insurance company.
Why do some mental health providers take insurance but most don’t?
There are many psychotherapists/counselors that do become in-network providers. By doing so, these therapists must see a higher amount of clients in order to achieve median/normal income level for the State of New Jersey. By doing this, they have less time to dedicate to the individual needs that each client presents and has less creative time to provide higher quality, more effective sessions. Most psychotherapists/counselors choose to be out of network so that they can provide better quality services outside of the limitations that are created by the larger, privatized health insurance companies.
We understand the need for valuable mental health services and the current health care system limits the potential for this when accepting contracted health insurance rates. Each individual claim made under a contracted in-network health care plan is subjected to many hours of work outside of the sessions to obtain and fight for reimbursement, many times resulting in no payment at all. This limits the provider’s ability to offer exceptional services. For these reasons, most mental health therapists/counselors choose to go out-of-network with health insurance companies, for the best interest of our clients.
How do health insurance companies reimburse for out-of-network services?
When anyone chooses to use their out-of-network benefits to receive covered services from out-of-network providers, the health insurance companies calculate the allowed amount for that service and pay based on the applicable fee schedule as stated in the member’s benefit plan. In some cases, the applicable fee schedule is one published by FAIR Health, Inc., an independent nonprofit organization selected by the Attorney General of the State of New York, and used by many states including New Jersey. This fee schedule is also used when a benefit plan refers to a usual or customary rate or other similar description.
In most cases, the health insurance companies will pay for the amount that is the lower of:
- The out-of-network provider’s actual charge billed to the member
- The standard reimbursement rate in the member’s contract (This rate is established by the employer or health plan sponsor for out-of-network reimbursement and defined in the member’s Summary of Benefits or the attachment to the member’s Certificate of Coverage)
- A published fee schedule, which may be the rates used by Medicare or a percentile of the FAIR Health fee schedule, referred to in the member’s Summary of Benefits or the attachment to the member’s Certificate of Coverage
- “The reasonable and customary amount,” “the usual, customary and reasonable amount,” “the prevailing rate” or other similar terms that base payment on what other health care providers in a geographic area charge for their services (the U&C Rate)
Usual and Customary Rates (U&C Rate)
The terms “the reasonable and customary amount,” “the usual, customary and reasonable amount” and “the prevailing rate” appear in some health benefit plans to explain the amount paid when out-of-network providers are used. These terms do not apply to plans with payment based only on Medicare, Medicaid or other defined rates.
The U&C Rate for benefit plans administered or insured by the health insurance companies is generally the 80th percentile of the FAIR Health fee schedule, unless the member’s Summary of Benefits or the attachment to the member’s Certificate of Coverage indicates another percentile. A payment calculated at the 80th percentile means that approximately 80 percent of providers who submit claims do so at the same or a lower calculated amount for that service in a particular ZIP code.
If your health care plan requires payment using FAIR Health or similar language, the health insurance companies refer to a fee schedule of provider charges created by FAIR Health, Inc., when deciding the maximum amount we will pay for such benefits.
FAIR Health publishes two databases called the Prevailing Healthcare Charges System (PHCS) database and the Medical Data Research (MDR) database. The information in these databases is updated and published by FAIR Health at scheduled times each year.
When the health insurance companies refer to the provider charge information in these databases to decide payment, the payment made to members or providers will, at times, be less than the amount billed by a provider for a certain service. This affects the out-of-pocket cost that members must pay to their out-of-network provider because the member is responsible for paying the difference between the provider’s charge and the amount paid by the health insurance companies.
To help members estimate their out-of-pocket expenses for out-of-network care, FAIR Health has developed an FH® Consumer Cost Lookup, available for free at www.fairhealthconsumer.org. Members can also find user-friendly educational materials at this site.
How FAIR Health Prepares the Databases
FAIR Health uses real provider charges — or when not enough information is on hand, fees based on an estimate using some charges and relative values. FAIR Health collects fee-for-service charges information from nationwide insurers. Before using the charges to create the databases, FAIR Health ensures that the information is accurate and complete. A team of experts works to identify and eliminate incorrect charges and reconcile negative or missing numbers.
Insurers that give information to FAIR Health get a discount on their license fees for the FAIR Health databases based on how much of their information is accepted and used. The health insurance companies do not now nor have ever given information to FAIR Health.
How FAIR Health Determines Charges
The PHCS and MDR databases organize charges by medical procedure codes, known as CPT codes, and by geographic area (geozips).
# of charges in database
What happens
For CPT code/geozip combinations with 9 or more actual charges.
The PHCS database reports those charges at the 50th, 60th, 70th, 75th, 80th, 85th, 90th and 95th percentiles. For example, the 80th percentile is the amount equal to or greater than 80 percent of the charges in the database for that CPT code/geozip combination.
For CPT code/geozip combinations with less than 9 actual charges.
The PHCS database reports derived charges in the percentile tables. To figure out derived charges, FAIR Health pools billed charges for similar services from the same geographic area. The charge data is standardized using relative values, which are numbers assigned to procedure codes based on a review of the difficulty and cost of the procedures. More complex and more costly procedures get higher relative values, while less complex and less costly procedures get lower relative values. The MDR database consists entirely of derived charges.
Any Other Questions
Please contact us for any additional questions you may have. We look forward to hearing from you!