ABOUT USING health INSURANCE & out-of-network benefits to pay for your care:

    • I am currently an out-of-network provider only, and do not accept insurance directly.

    • I am in the process of credentialing and paneling with a few private insurance companies’ care networks (BCBS, Aetna, HPHC), though this is not finalized now.

    • Many insurance plans offer out-of-network benefits that reimburse a portion of your therapy costs.

    • I can provide you with a monthly superbill for out-of-network claims for those seeking reimbursement.

    • It is your responsibility to inquire about your out-of-network benefits directly with your insurance provider.

    I’ve outlined a list of questions below for you to ask your insurance carrier to help you determine your financial responsibility for services:

    • Do I have out-of-network mental health benefits?

    • Do I have an annual deductible?

      • If yes, what is my out-of-network deductible, and has it been met? How much remains?

      • Once my deductible has been met, at what percentage do you reimburse for these services (or, what percentage of the fee is covered per session)?

        • Is this based on the “allowed amount” or the provider’s full fee?

          • Is there an out-of-pocket limit (beyond which my insurance covers 100% of the allowed amount or full fee)?

        • If this is based on the allowed amount, what are the allowed rates for these CPT codes?

          • CPT Code 90791(Initial Intake/Diagnostic Evaluation - Telehealth)

          • CPT Code 90837 (60-Minute Psychotherapy Session/Ongoing Care - Telehealth)

            • Once you receive the above CPT code reimbursement rates from your insurance carrier, I am more than happy to help you determine your remaining financial responsibility when using your out-of-network benefits to pay for services.

    You can use the following information when checking benefits:

    • EMMA DAUPHINAIS, LMHC NPI1: 1043074321

    • PSYCHOTHERAPY WITH EMMA LLC NPI2: 1225961626

  • If you have out-of-network benefits, I can provide you with a monthly superbill through the SimplePractice client portal that you may submit to your insurance company for potential reimbursement.

    • Once you’ve confirmed coverage (see steps in previous point), ask your health insurance provider if they require a preauthorization or a referral before psychotherapy services begin.

      • If so, who needs to submit the referral (e.g., a primary care physician)? And to whom?

    • You should ask them how you are required to submit claims to them (fax, mail, online portal, etc.) to seek reimbursement.

      • Depending upon your insurance provider, you may be required to submit a form related to the requested reimbursement with your provider.

        • Ask specifically what they require you to upload/send, and if you’re required to upload/send the same things to them each time (e.g., monthly) that you are seeking reimbursement.

    • Advise your insurance provider that I can provide you with a once monthly superbill, outlining 1 month of charges at a time. Let them know what is included in my superbill typically, and ask if they require any additional information to approve services:

      • Provider Information (My Information)

        • My full name and credentials

        • Practice name

        • Practice address

        • Practice phone number

        • NPI number 1 (Individual)

        • NPI Number 2 (Practice)

        • Tax ID/EIN

        • MA state license number

      • Patient Information (Your Information)

        • Your name

        • Your date of birth

        • Your insurance member ID

        • Your subscriber information (if different from the patient)

      • Service Information

        • Date(s) of service

        • CPT code(s) (e.g., 90837, 90791)

        • DSM-V-TR/ICD-10 diagnostic code(s)

        • Place of service (telehealth)

        • Session fee(s) charged

        • Amount paid by patient

    • Typically if out-of-network benefits are covered by your insurance provider, once these steps are taken, and if your information is approved, your insurance provider will then process your claims, send along an EOB (explanation of benefits), and send payment (reimbursement) directly to you once eligible.

    • Whether you use in-network benefits or seek reimbursement through out-of-network benefits, insurance companies generally require a mental health diagnosis as part of the billing process. This diagnosis is used by the insurer to determine medical necessity and eligibility for coverage of services.

    • When insurance is involved, certain information related to your treatment—including your diagnosis, dates of service, and billing information—becomes part of your insurance record.

      • Depending on your plan and the circumstances, your insurance company may also request additional information to review or process claims.

    • Many people find that using their insurance benefits makes therapy more financially accessible, and reimbursement is often an important part of receiving care. At the same time, it is important to understand that insurance coverage requires a level of disclosure that differs from paying privately without involving an insurance company.

    • If you have questions about the role of diagnosis in treatment, insurance reimbursement, or confidentiality, I am happy to discuss these considerations with you so that you can make an informed decision about your care.

  • Patients may choose to pay privately for therapy sessions rather than use any insurance benefits. Private pay offers greater flexibility and privacy, as information about treatment is not submitted to an insurance company.

    Private Pay Benefits

    • No diagnosis is required for insurance reimbursement purposes.

    • Greater confidentiality, as treatment information is not shared with insurance providers.

    • More flexibility in determining the frequency and length of treatment.

    • Freedom to focus on personal growth, life transitions, relationship concerns, and other issues that may not meet insurance medical-necessity criteria.

    If you have questions about private pay services, or would like to discuss whether private pay or insurance is the best option for your situation, please contact me directly.

    • All major credit cards, HSA, and FSA cards are accepted forms of payment.

    • Payment is due at the time of service and is securely processed through SimplePractice.

      • If you wish to privately pay for services, payment is due in full at the time you receive services ($185/session, $200/intake session x2).

      • If you wish to use your out-of-network benefits, payment is due in full at the time you receive services ($185/session, $200/intake session x2).

      • If you’re utilizing health insurance benefits, you will be required to pay a co-payment each session.

        • This is an amount that’s predetermined by your insurance company. You can call them directly (utilize the number on the back of your card) to determine this. Some insurance companies list behavioral health co-pays directly on the back of your insurance card.

        • It is your responsibility to determine this amount before treatment begins.

        • It is your responsibility to pay this amount each session for services.

  • *** Applicable to patients (or potential patients) planning to private pay or pay up-front and use out-of-network benefits to seek reimbursement for services.***

    The "No Surprises Act" went into effect on 01/01/2022. The intention of this law is to protect individuals from being billed unexpectedly for out-of-network healthcare.

    • For the patients indicated above, "Good Faith Estimates" are included in your intake paperwork, and outline expected charges. 

    • You have the right to receive a “Good Faith Estimate” explaining how much your medical 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 bill for medical items and services.​

      • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.​

      • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or 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 or call 1-800-985-3059.

    • Therapy is an investment in your emotional well-being, relationships, and overall quality of life. It is an opportunity to dedicate time and resources to your mental health, personal growth, and the life you want to create.

    • While it requires a financial commitment, many patients find that the insights, skills, and lasting changes gained through therapy provide benefits that extend even after therapy sessions end.

    • I strive to make this investment meaningful, collaborative, and tailored to your goals.