We work out-of-network (OON) with most PPO plans including Anthem, Blue Shield of California, HealthNet, UnitedHealthcare, Cigna, and Optum. OON means you pay for sessions upfront and can seek reimbursement from your insurance provider.

As a complimentary service, we check your eligibility and obtain an estimate of your coverage. After each session, we submit the claim to insurance on your behalf. Any reimbursement is sent directly to you by your insurance provider.

Note that your annual deductible needs to be met before any reimbursement is made and coverage is often partial depending on your particular plan and the allowed amount applied.

Out-of-network means that we are not contracted in-network with your insurance company, so you cannot use your insurance directly as payment.

Thankfully, most PPO plans include separate out-of-network benefits that allow you to see providers outside their network and reimburse a portion of the cost.

Correct, we are out-of-network, not in-network. That means that you CANNOT use insurance for upfront payment and in-network benefits do NOT apply.

We also do not participate with Medicare, Medi-Cal, Medicaid, or HMO plans.

Your deductible is the amount you first need to reach in out-of-pocket costs before your insurance will begin to cover services.

Some plans have separate in-network and out-of-network deductibles, so make sure to check carefully.

Most insurance companies cap the rate on which coverage is based for each particular service in each particular zip code. This is called the allowed amount.

The allowed amount is not public and can typically only be confirmed once your first claim has been processed. After processing, your insurance company will send you an Explanation of Benefits (EOB) showing how the claim was calculated, including the allowed amount and any reimbursement. This usually arrives within approximately 4–6 weeks after the claim is submitted.

Depending on your insurance company, we may be able to estimate the allowed amount upfront.

Coinsurance is the percentage of the allowed amount that you are responsible for paying after your deductible has been met.

The coverage percentage is the percentage of the allowed amount that the insurance provider will reimburse after your deductible has been met.

Your copay is a fixed dollar amount that reduces what your insurance will reimburse. Typically plans either have a copay or coinsurance, not both.

Assuming a session rate of $200 and that your plan has a 50% coinsurance and an allowed amount of $150 and you have already met your deductible. Then, you will pay $200 upfront and be reimbursed $75 (50% of $150). Therefore, the out-of-pocket cost to you will be $125.

If you had not met your deductible, you would be responsible for the full $200.