NYC Therapyfilter: share your reasonable and customary charges?
October 18, 2018 12:22 PM Subscribe
Help me figure out if switching insurance plans will make my care more affordable by sharing what your NYC-based insurance has been willing to pay as a reasonable and customary charge for out of network, outpatient talk therapy. More clarifying details under the cut.
I have an Anthem BlueCross BlueShield EPO through my husband's work. It doesn't cover out-of-network care. I am seeing a psychotherapist (PhD Clinical Psychology, no MD) for talk therapy for depression and anxiety who is out of network, and paying $275 per session out of pocket for it. This is currently more than I'm spending on rent.
We have the option of switching to a PPO plan, which will reimburse for out of network care at 70% of the reasonable and customary charge after deductible. The premium is about twice as much and the deductible is a lot higher for the PPO than our current EPO, so the cost/benefit analysis of switching comes down to how much I will actually get reimbursed, after the deductible, per session. Anthem refuses to tell me what their reasonable and customary charge is for therapy. So I am calling on you, MeFites, for data if you can share.
If you have received reimbursement for individual psychotherapy in New York, what did your insurance consider a reasonable and customary charge? My therapist is in Manhattan, specifically zip code 10016. The code she would submit with is 90837 AH, 60 minutes outpatient talk therapy with a clinical psychologist. this site puts typical reasonable and customary charges for 90837 in 10016 at $550+, which at 70% reimbursement would put me more than in the clear. If you feel comfortable sharing please let me know your data points so I can try to make an informed decision.
Please assume I'm not looking to switch providers, and am currently getting the lowest fee possible from my therapist.
I have an Anthem BlueCross BlueShield EPO through my husband's work. It doesn't cover out-of-network care. I am seeing a psychotherapist (PhD Clinical Psychology, no MD) for talk therapy for depression and anxiety who is out of network, and paying $275 per session out of pocket for it. This is currently more than I'm spending on rent.
We have the option of switching to a PPO plan, which will reimburse for out of network care at 70% of the reasonable and customary charge after deductible. The premium is about twice as much and the deductible is a lot higher for the PPO than our current EPO, so the cost/benefit analysis of switching comes down to how much I will actually get reimbursed, after the deductible, per session. Anthem refuses to tell me what their reasonable and customary charge is for therapy. So I am calling on you, MeFites, for data if you can share.
If you have received reimbursement for individual psychotherapy in New York, what did your insurance consider a reasonable and customary charge? My therapist is in Manhattan, specifically zip code 10016. The code she would submit with is 90837 AH, 60 minutes outpatient talk therapy with a clinical psychologist. this site puts typical reasonable and customary charges for 90837 in 10016 at $550+, which at 70% reimbursement would put me more than in the clear. If you feel comfortable sharing please let me know your data points so I can try to make an informed decision.
Please assume I'm not looking to switch providers, and am currently getting the lowest fee possible from my therapist.
Ask your provider, they may be currently be reimbursed by a similar plan to calculate your charges.
posted by AlexiaSky at 1:12 PM on October 18, 2018
posted by AlexiaSky at 1:12 PM on October 18, 2018
Response by poster: Not to threadsit- but add to the above assumptions that I have also asked my provider to furnish me with any info she has, and am also pushing Anthem for more info, and am not looking for other strategies. What I am looking for in this ask is, if anyone is comfortable sharing, what they have received as a reasonable and customary charge for talk therapy in New York City from their insurance provider. I know the number will be variable but a range is more useful to me than no data at all. Thanks!
posted by socktastic at 1:19 PM on October 18, 2018
posted by socktastic at 1:19 PM on October 18, 2018
Best answer: Medicare reimburses that code at 145 for Manhattan. Link. So that should be the absolute floor for reasonable and customary. I would anticipate a more generous reimbursement from a private insurer, but I'm not sure by how much.
A few things:
1. Your premium isn't subject to income tax, so you won't see as large a hit in your paycheck as you'd expect.
2. Do you have access to an HSA or FSA through either employer? This will allow you to pay part of your deductible with pre-tax income. I believe employers are required to offer an HSA for high deductible plans.
3. Does the plan have an out-of-pocket maximum? Mine does, and with my other health care needs, I basically get free therapy for the last 3 months a year.
posted by politikitty at 4:05 PM on October 18, 2018 [2 favorites]
A few things:
1. Your premium isn't subject to income tax, so you won't see as large a hit in your paycheck as you'd expect.
2. Do you have access to an HSA or FSA through either employer? This will allow you to pay part of your deductible with pre-tax income. I believe employers are required to offer an HSA for high deductible plans.
3. Does the plan have an out-of-pocket maximum? Mine does, and with my other health care needs, I basically get free therapy for the last 3 months a year.
posted by politikitty at 4:05 PM on October 18, 2018 [2 favorites]
Best answer: I have a city plan. The schedule is $55
In NYS, the insurer is legally obligated to tell you this information. I also had to go through the attorney general's office to force them to share the info. They really don't like being transparent about it.
posted by Salamandrous at 2:20 PM on October 22, 2018
In NYS, the insurer is legally obligated to tell you this information. I also had to go through the attorney general's office to force them to share the info. They really don't like being transparent about it.
posted by Salamandrous at 2:20 PM on October 22, 2018
This thread is closed to new comments.
posted by praemunire at 12:58 PM on October 18, 2018