Billing and Insurance
Frequently Asked Questions:
Do you accept insurance?
Yes! All clinicians at Three Oaks Behavioral Health & Wellness are in-network providers with Aetna, Evernorth (formerly known as Cigna) & Blue Cross Blue Shield including all PPO plans, Blue Advantage, Blue Select, Blue Care, Classic Blue, Blue Options, NC State Health Plan, Blue Federal, and Out of State BCBS PPO plans.
We also accept the [North Carolina State Health Plan]. Teachers, state employees, retirees, and their dependents are eligible for health coverage through the Plan. Additionally, we are able to bill out-of-network with other major insurance companies.
Our practice is not in-network with: BCBS Blue Value, Blue Local, Blue Home, United, Tricare, Medicare and Medicaid.
If using health insurance, insurance companies & employee assistance programs (EAPs) often require that you receive a mental health diagnosis in order to access benefits. This mental health diagnosis becomes part of your permanent medical record. We will inform and discuss with you any relevant diagnosis. Please consider this information when determining whether private pay or filing with your insurance is the desired option for you.
*Note: If the client is NOT the primary insured person, please include the policy holder's full legal name in addition to the client's name. (Example: The client is a minor and/or dependent & is insured under their parent; The parent’s legal name and date of birth needs to be shared.)
It is ultimately the responsibility of the client to monitor their insurance benefits (meeting deductible, copay changes, etc). We highly encourage that you also reach out to your insurance company to verify the same information. Our group NPI is 1528563194 and the primary CPT codes used for outpatient therapy sessions with our providers are 90837 and 90791. When you call your insurance company and provide them with the NPI & CPT codes, they should provide you with the same verification information our billing team provides.
Any relevant deductible, copay or coinsurance amount will be expected at the time of your therapy session and will be processed by your provider.
We ask all clients to notify us as soon as possible when they believe they have met any relevant deductible or have any change to their insurance as this will impact the amount owed for each session. Inaccurate billing information could lead to outstanding invoices that are the responsibility of the client to reconcile. We want to prevent outstanding balances by ensuring all insurance & billing information is accurate and up-to-date. Thank you for partnering with us in this effort!
What are the session fees?
Individual Therapy: Initial Session/Clinical Assessment (60-75 minutes): $200
Individual Therapy: Ongoing Sessions (50-53 minutes): $160
Couples/Family Therapy: Initial Session/Clinical Assessment (60-75 minutes): $230
Couples/Family Therapy: Ongoing Sessions (50-53 minutes): $200
Reduced Rate/Sliding Scale Sessions (50-53 minutes): Please inquire. See 'Working with an Intern' section below.
A full payment- or any relevant copay- is required at the time of service delivery. Cash, check, credit cards, FSA & HSA are accepted. Please remember that you are responsible (and not your company, attorney, or adjunct service provider) for paying the fees agreed upon.
Documentation and/or communication outside of your session will be billed based on time spent and commensurate with hourly appointment rates. For example, a letter written for an attorney: time spent = $70/30 minutes (equivalent to a 30 minute session at a rate of $140/session).
What methods of payment do you accept?
Cash, check, credit card, Flex Spend Accounts (FSA) and Health Savings Accounts (HSA) are accepted forms of payment.
*Regardless of payment method, we ask that a credit card be saved on file.
I have a billing question. Who can I connect with?
Please reach out to our Billing Team via email:
clients@threeoaksbehavioralhealth.com
Do you offer sliding scale/reduced rates, or payment plans?
We are dedicated to providing quality mental health care services & do not want finances to be a barrier to treatment. Some of our therapists offer flat-fee, reduced rate sessions for select appointment times and clients in need. Please ask about the availability of our clinicians' reduced rate fees & payment plan options during your first communication with us.
Self-paying clients, or those who are considered out-of-network with our contracted insurance plans, are eligible for reduced fee services. We are unable to offer payment plans to clients utilizing insurance as that would put us in violation of our contracts.
See 'Working with an Intern' section below:
What's it like working with a Clinical Student Intern at a reduced rate?
Working with a Clinical Student Intern allows for much financial flexibility. Insurance companies are not able to reimburse interns for services. This means that Three Oaks interns are able to schedule clients on a sliding scale or "reduced rate" basis, allowing you and the Clinical Student Intern to negotiate a cost per session together.
Three Oaks believes that finances should never be a barrier to getting exceptional counseling services. Our Internship Program plays a huge role in Three Oaks being able to welcome clients to the practice who are uninsured or otherwise unable to budget for professional therapeutic support.
Also, working with an intern is an excellent option for folks who do have insurance but do not want to submit a mental health claim through an insurance company. Submitting insurance claims requires the need for a mental health diagnosis which becomes part of the client's permanent medical record.
Learn more about our Three Oaks interns [here].
Are you an out-of-network provider?
If we do not accept your current insurance plan, you may be eligible to use your out-of-network benefits. We are happy to provide you with a "superbill" for your services. (A superbill is an itemized form- similar to a receipt- that is used to create a healthcare claim, which can then be submitted for potential reimbursement.)
Please follow the steps below to determine your own reimbursement and benefits made available to you from your insurance provider. Three Oaks' Group NPI number is: 1528563194. Keep careful records of your conversation in the event you need to appeal a future decision by the insurance company regarding reimbursement. Call the number on the back of your insurance card to reach the Benefits Department and ask the following questions:
- What is the representative's name and extension number?
- Does my policy cover an Out-of-Network, Licensed Clinical Mental Health Counselor/Licensed Clinical Social Worker/Licensed Clinical Addiction Specialist/Certified Rehabilitation Counselor?
- My therapist is willing to provide a statement, or superbill, of Session Dates Attended, the CPT code, and the diagnosis. Is this acceptable to the insurance company?
- Does my policy cover Individual Psychotherapy (CPT code: 90834 or 90837)?
- What mental health diagnoses are NOT reimbursable?
- How many sessions are covered per year?
- What is the lifetime maximum for mental health benefits?
- What is my Out-of-Network deductible?
- What is the allowed amount of the fee?
- What percentage of the allowed amount will be reimbursed?
- How do I file a claim?
Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid ($80 of the total $100 fee). Other companies will substitute the $100 fee for what they deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you 80% of the "allowed amount of the fee." (You paid $100 for an individual session, but your insurance company only allows $80; therefore you will be reimbursed 80% of the $80, or $64.)
We have partnered with Mentaya to help our clients use their out-of-network insurance benefits to save money on therapy. Please use the tool below to see if you qualify for reimbursement for our therapy services!
General
Frequently Asked Questions Continued:
How do I schedule a session?
We are so glad you're here! Please fill out the contact form found [here]. We look forward to connecting with you! Please allow 2 business days for a response.
Additionally, you may reach out directly to your preferred provider via email to discuss appointment availability & schedule your visit. Clinicians who are currently available & accepting new clients can be found [here].
*Existing Clients: Sign in to your SimplePractice client portal [here].
What is your policy for cancellations?
We ask that at least 24 hours notice be given for appointment reschedules/cancellations, including weekend days. Reschedule requests or cancellations within 24 hours of the scheduled appointment time, including unattended sessions (“no show, no notice”), will result in a full-fee charge.
(A full-fee charge is equal to the total amount of your session fee. Please note: for self pay sessions, this is $140. For in-network sessions, this is dependent on the clients' contracted insurance rates. For example, if a full-fee BCBS session is $118.20, the full-fee charge for a late cancellation would be $118.20.)
We do understand that scheduling adjustments are necessary at times. As a courtesy, we will grant one “no charge” late cancellation before the aforementioned policy goes into effect. Providers reserve a time commitment exclusively for you, therefore your session time may be lost. If you are late for a session by 15 minutes or more, you may be asked to reschedule a session.
Out of respect for others & to ensure as many folks have access to treatment as possible, we ask that you please contact your provider to cancel/reschedule an appointment as soon as it becomes necessary.
Do you offer group therapy?
Yes, many of our clinicians are passionate about facilitating groups! Please visit our Groups page [here] to learn more about our current group schedule.
Do you offer medication management?
No, Three Oaks does not currently offer psychiatric support. We are happy to share a referral list with you! If you would like a list of trusted referrals for prescribing providers, please complete the online contact form.
What do I need to bring?
Initial Session/Clinical Assessment: Insurance card, photo identification, method of payment, relevant intake paperwork & any medical records or documentation that you believe your therapist would benefit from reviewing. Before your first appointment, you will be sent an invitation to access your client portal via SimplePractice. Please ensure that all documentation is complete prior to your first visit with us. All intake documentation is completed electronically. Please connect directly with your provider if you need support completing the intake forms.
Ongoing Sessions: Method of payment (if this differs from what is stored in your client profile); If at any time your insurance coverage changes, please let us know as soon as possible in order to avoid billing discrepancies.
Many clients can benefit from keeping a journal throughout their therapy visits. Journaling tends to be very helpful since it serves as a single, personal place to track happenings throughout the week. You're more than welcome to take notes during sessions with your provider if this feels right.
Will I get a mental health diagnosis?
If you plan to use health insurance to pay for treatment, insurance companies and employee assistance programs often require that you receive a mental health diagnosis in order to access benefits. This mental health diagnosis becomes part of your permanent medical record. We will discuss and inform you of any relevant or applicable diagnosis. Please consider this information when determining whether private pay, or filing with your insurance, is the desired payment option for you. A diagnosis can also be provided, upon request, for clients participating in private pay sessions.
How long will treatment last?
Treatment length varies and depends largely on your therapeutic goals. You may prefer brief, solution-focused methods and can enjoy "results" in 4-6 weeks. Practicing & learning new skills are likely to result even after your first session. You may also utilize these visits as a way to explore and brainstorm ideas, thoughts, and beliefs or face larger, more complex issues while utilizing therapeutic benefits for a longer period of time.
We often lightheartedly say to our clients, "Our best day is when you come in and fire us." This means that you have courageously engaged in treatment and have found whatever it is you were seeking. In accomplishing what you were striving for, you can now enjoy a life of freedom and balance. The achievement of this state of healing will vary for each person. For each individual, the amount of time it takes to find that place of peace is different.
Do you offer court appearances or testimonies?
Yes, with a court ordered subpoena signed by a judge, we will make court appearances & provide testimonies under subpoena in Wake County at the rate of $1,500 per day. Appearances outside of Wake County will incur additional fees.
What are the core values of Three Oaks and its team members?
We [therapists, helpers, human-facing workers] deserve better. Three Oaks Behavioral Health & Wellness is on a mission to create a workplace where therapists can practice their calling while feeling supported, balanced, and nourished; resulting in truly extraordinary work and client care that does not contribute to or promote burnout. Global goal: play our part in helping as many HELPERS stay engaged in the mental health field, and enjoy longevity in the industry, as long as possible. We believe that when helpers are cared for, they are able to practice, grow, and develop their craft; leading to excellent client care and outcomes. Three Oaks' Core Values can be found [here].