Billing & FAQs

Thriving Minds accepts Traditional and PPO Blue Cross Blue Shield. We make every effort to determine the coverage of patients; however, we also ask that patients explore their own coverage and are knowledgeable about co-pays and deductibles prior to the first appointment.

Out-of-Network: Thriving Minds is an “out-of-network” provider for all other insurance carriers. We are sensitive to clients’ needs for affordable mental health care and can help clients navigate the process of submitting claims for reimbursement.

Navigating Out-of-Network: To determine if your insurance company will reimburse you for payments made to Thriving Minds, ask if you have “out-of-network benefits” for mental health services and, if so, at what percentage you will be reimbursed for each session. You may also have out-of-network benefits that would cover all or a percentage of our fees. Most patients report obtaining 60-100% coverage out-of-network. If you’d like to find out whether your insurance company will reimburse you for the cost of therapy or testing with us you should contact your insurance company.

Thriving Minds checks insurance benefits for our internal billing purposes, but we do not reach out to inform clients about their coverage details. It is the client’s responsibility to confirm their coverage directly with their insurance provider before starting services. We strongly recommend calling your provider, writing down who you spoke to, and noting the date and time of the call. This ensures you are fully aware of your coverage and any potential costs you may owe.

When contacting your insurance provider to understand your coverage for behavioral health services, consider asking the following questions:

Is Thriving Minds Behavioral Health an in-network provider?

Confirming this can help you avoid higher out-of-pocket costs associated with out-of-network services.

Do you offer out-of-network benefits?

If Thriving Minds Behavioral Health is not in-network, inquire about coverage options and potential reimbursement rates for out-of-network services.

What are my coverage details for the following CPT codes:

• 90791: Psychiatric diagnostic evaluation

• 90834: Psychotherapy, 45 minutes with patient

• 90837: Psychotherapy, 60 minutes with patient

• 90785: Interactive complexity add-on

• 90846: Family psychotherapy without the patient present

• 90847: Family psychotherapy with the patient present

Understanding your coverage for these specific services will help you anticipate any out-of-pocket expenses.

Is pre-authorization required for any of these services?

Some insurance plans require prior approval for certain services. Knowing this in advance can prevent unexpected denials.

What are my copayment, coinsurance, and deductible amounts for behavioral health services?

Clarify your financial responsibilities to better plan for any costs not covered by insurance.

What is my deductible, and how much of it have I met?

Your deductible is the amount you need to pay out of pocket before your insurance begins covering services. You can check the current status of your deductible by logging into your insurance provider’s online portal or contacting their customer service line. This will tell you how much of your deductible you’ve already met for the year.

How do I access the forms needed to submit a reimbursement request?

Many providers offer downloadable forms online, and their customer service representatives can guide you through the submission process.

Is there a limit to the number of sessions covered per year?

Some plans have annual caps on the number of covered therapy sessions.

Are telehealth or online therapy sessions covered?

With the rise of telehealth, it's important to know if your plan includes coverage for virtual therapy sessions.

Are there any exclusions or limitations for behavioral health services?

Understanding any restrictions can help you avoid unexpected expenses.

By asking these questions, you can gain a comprehensive understanding of your insurance coverage for behavioral health services and make informed decisions about your care.

Health insurance can be confusing and challenging to navigate. This information is not meant to replace information from your specific health insurance company, but to assist in understanding how families can potentially seek out-of-network benefits at Thriving Minds.

Thriving Minds is only in-network with Blue Cross Blue Shield PPO and Traditional. All other insurances would be considered “out-of-network,” meaning that Thriving Minds does not directly accept the insurance and therefore does not process the claim on the family’s behalf.

Some insurances have out-of-network benefits. Thus, families can submit their “superbill” (treatment receipts) for reimbursement and/or a credit toward the deductible (the amount of money insurance requires the holder to pay prior to coverage for health costs). In this scenario, the family pays Thriving Minds “out of pocket”, or at the full rate, then submits the superbill (typically online) and the insurance company pays the family directly with a check.

However, depending on what kind of insurance the family has, it could mean that:

1. The insurance company will not reimburse at all for treatment costs (more common of HMO plans)

2. The insurance company may reimburse for a portion of the treatment costs, but at a rate lower than they would cover for an in-network provider

3. The insurance company will not credit the deductible at all

4. The insurance company will credit the out-of-network deductible instead of the in-network deductible. This might make it difficult to meet the deductible(s).

How to Get Started

Here are the steps to find out about your potential “out-of-network” coverage:

Call the number on the back of your insurance card (some cards have a different number for behavioral health). Speak to a customer support representative asking about your out-of-network benefits and how to access those.

The representative may ask for CPT codes, which are codes used for describing the procedures conducted in the session (e.g., psychotherapy).

Specific CPT codes to reference for therapy include: 90791, 90837, 90834, 90832, 90846, 90847.

Specific CPT codes to reference for testing/evaluations include: 96130, 96131, 96132, 96133, 96116, 96136, 96137, 96138, 96139.

Ask if you have an out-of-network deductible and what that amount is. This tells you what you would be responsible to pay before insurance starts to cover a portion of the sessions.

If you do have an out-of-network deductible ask, “What percentage of the out of network costs does [insurance company] cover after the deductible is met?”

Ask what the process is for you to get reimbursed for out-of-network services. Some companies have an online portal for uploading the superbill for reimbursement, while others require that the information is mailed in. Be sure to regularly submit these superbills; many families submit them monthly.

Make note of the date, time, and person’s name you spoke to on this call.

90791 (60-90 minutes) = Intake appointment

90834 (45 minutes) = Individual Psychotherapy

90837 (60 minutes) = Individual Psychotherapy (most frequently used code for therapy at Thriving Minds)

90846 (60 minutes) = Family Therapy without client

90847 (60 minutes) = Family Therapy with client

96136-37, 96138-39, 96130-31, 96132-33, and 96116 (60 minutes) = Psychological Testing. Please note that testing time includes scoring, interpretation, report writing and time spent contacting other professionals, in addition to face-to-face meetings.

The initial consultation is approximately $250. Following that, therapy sessions range from $150 to $250 per hour, depending on factors such as the type of therapy and the clinician's degree.

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 CMS.gov website.

We understand that shared payment responsibilities can be important for families. However, it is our policy to have one designated responsible payor on the account to ensure smooth and efficient billing. We appreciate your understanding and ask that families coordinate payment arrangements between themselves as needed.

There are several factors that contribute to the cost of a session, including the length of the session, who was involved, and the type of service provided. Because of these variables, it is not uncommon for session charges to vary from week to week.

Thriving Minds collects your estimated portion of the session cost and typically charges the card on file 1–2 business days after your appointment. If we are in-network with your insurance, we will still submit the claim to your provider. Once the claim is processed, if you have overpaid, we will reimburse you accordingly.

At Thriving Minds, we strive to keep our billing process consistent and manageable so we can focus on providing quality care to all of our clients. Due to the number of families we serve, we are unable to accommodate alternate payment arrangements. We appreciate your understanding and are happy to provide receipts or Superbills if needed for reimbursement or financial planning.

We understand the desire to have control over weekly payments. However, due to the high volume of transactions we process each day, we are unable to offer individual approval for each charge. As outlined in our intake paperwork, we will charge the card on file for the estimated portion of your session cost, typically within 24 hours of the appointment.

This process helps keep billing efficient and consistent, allowing us to focus on providing quality care.

We appreciate your understanding and are happy to provide receipts or answer any billing questions you may have.

We understand that navigating out-of-network insurance can be challenging, and we wish we could accommodate every request. However, due to the administrative demands involved, we are not able to pursue single case agreements or complete pre-authorizations for out-of-network plans.

We are happy to provide detailed receipts or Superbills to support you in seeking reimbursement directly from your insurance provider.

We understand this can be confusing. While BCN may describe the process as a simple form, these requests are typically part of a single case agreement, which means the provider is being asked to work directly with an insurance company we are not contracted with. Due to the extensive administrative demands inherent in these requests, Thriving Minds does not enter into these types of agreements and does not communicate directly with out-of-network insurance plans.

Instead, we support families by providing detailed receipts or Superbills that you can submit to your insurance for potential reimbursement.

What is a Coordination of Benefits (COB)?

COB is how insurance companies decide which plan pays first when a person has more than one insurance policy—like when a child is covered by both parents. This helps prevent duplicate payments and ensures accurate claims processing.

Why does COB matter for my therapy at Thriving Minds?

If COB information is missing or outdated, your insurance may pause or deny claims, even if coverage was active before. This can lead to:

• Delayed or denied payments

• Out-of-pocket costs for you

• Possible pauses in therapy until it’s resolved

Why do I have to update it?

Only the policyholder can update COB info—insurance companies won’t accept this from Thriving Minds. Many insurers require updates annually or when your coverage changes.

How do I complete it?

• Log into your insurance company’s portal

• Call the customer service number on your card

• Respond to any requests from your insurer

What happens if I don’t?

Claims may be denied, therapy may be interrupted, and you may need to cover session fees until COB is completed. Keeping it current helps ensure uninterrupted care.

If you’re using insurance for therapy, you may see terms like copay, deductible, and coinsurance—but what do they actually mean for your out-of-pocket costs?

Copay
A copay is a fixed amount you pay at each session, such as $20 or $30. It’s your portion of the cost, and insurance covers the rest. Think of it as your “entry fee” for each visit. This amount is usually the same for every visit, regardless of the type or cost of the session.

Deductible
Your deductible is the total amount you need to pay out-of-pocket each year before your insurance starts helping with costs. For example, if your deductible is $1,000, you’ll need to pay that amount for services (including therapy) before insurance begins contributing.

If your sessions cost $200 each (just using round numbers as an example—not actual session costs), you would pay $200 per session until you reach the $1,000 deductible. After that, insurance typically begins to cover more of the cost, and you may only need to pay a smaller portion—such as a copay or coinsurance.

Coinsurance
Coinsurance means you pay a percentage of the cost of each session, and your insurance covers the rest. This may apply after you've met your deductible or even while you're still working toward it, depending on your plan.

For example, if your plan includes 20% coinsurance and sessions cost $200 each (just a sample amount for clarity—this is not the actual cost), you would pay $40 per session, and your insurance would cover the remaining $160.

Why it matters
Understanding these terms can help you avoid surprises and plan for the cost of care. Your specific costs will depend on your insurance plan. If you’re unsure how these apply to you, we’re happy to help you understand what to ask your insurance company.

It is Thriving Minds’ policy to collect payment at the time of service. To keep things simple and avoid large, unexpected balances later, we collect payment upfront based on your estimated cost.

Insurance companies often take several weeks (and sometimes months) to process claims. Once your insurance company completes its review, we reconcile your account:

• If insurance pays more than expected, we typically issue a refund or apply a credit within 30 days of receiving the insurance payment.

• If insurance pays less, we bill you for the remaining balance.

To speed up the process, you can also schedule an online meeting with our billing staff to review your account and see if a refund can be issued sooner.