Private Self-Pay vs Using Insurance Benefits:

Self paying for mental health services is often preferred by our clients because due to the nature of the insurance-based medical model. In other words, when you use health insurance benefits to pay for psychotherapy services you waive certain rights to confidentiality.

In order to pay for any individual’s treatment, insurance companies require that treatment be medically necessary to improve the individual’s symptoms and level of function related to a diagnosable mental health condition. When we bill an individual’s insurance, health insurance companies require that for each date of service, the clinical documentation includes a diagnosed mental health condition for the individual receiving services, details and updates after each session about their symptoms and daily functioning, treatment goals and objectives aimed at improving symptoms and daily function, ongoing monitoring of therapeutic progress and prognosis, all to support ongoing medical necessity of the therapy. This means that your insurance carrier would have access to your clinical records including progress notes, if requested.

Still planning to use insurance benefits? Here are some questions to ask your insurance carrier prior to making an appointment:

We expect new clients to have a full understanding of their health insurance benefits prior to beginning treatment.

• Do I have mental health coverage?

• Do I need a referral?

• How many sessions are covered per year?

• If the therapist I want to see is out-of-network, do I have out-of-network benefits that would cover the service?

• Are telehealth services covered by my insurance plan?

• If I have a copay due at time of service, what is the amount?

• Do I have a deductible to meet before a copay applies?

• If I have a deductible to meet, what is the amount and has it been met?

Evergreen Pathways is in-network with the following insurance carriers:

• Harvard Pilgrim Health Care

• United Healthcare / Optum / Oxford

• Anthem / Blue Cross Blue Shield of Any State

Out of Network Benefits:

If you have out-of-network insurance benefits and we are not considered in-network by your insurance plan, we can provide a superbill for any services rendered for individual therapy. We will discuss this with you when services are established.

No Surprise Billing:

Under section 2799B-6 of the Public Health Service Act, healthcare providers and healthcare facilities are required to inform individuals of their expected charges when they are not enrolled in a plan or coverage or a Federal healthcare program, or not seeking to file a claim with their plan or coverage both orally and in writing. Upon request, or at the time of scheduling healthcare services, healthcare providers and facilities must provide to their clients, a “Good Faith Estimate” of expected charges.

What forms of payment are accepted?

Payment is due at the time of service. We accept cash, check, and all major credit cards.