Rachel Pires, LCSW is considered an Out of Network Provider
At this time, Rachel Pires is an out-of-network provider for all insurance companies - see below for details about why.
Depending on your current health insurance provider or employee benefit plan, it is possible for services to be covered in full or in part. Please contact your insurance provider directly to verify how your plan compensates for out-of-network psychotherapy services. Calling your insurance before your first appointment is recommended so there are no surprises down the road.
Questions to ask Your Insurance Company
Calling your insurance company prior to your first appointment is recommended. Here are some tips on how to check on your out-of-network coverage and benefits. Plan for at least 15-30 minutes of your time to call your insurance company. Make sure to have all of your identifying information ready (such as your insurance card). Questions to ask:
Do I have a mental or behavioral health policy with out-of-network benefits?
Do I have an out-of-network deductible? If yes, ask: a) What is my out-of-network deductible? b) How much of my out-of-network deductible has been met? c) What is the start date of the calendar year my out-of-network policy is based on?
What are the requirements to use out-of-network benefits?
Is prior authorization required? If so, what is the process for obtaining prior authorization?
Is a referral required from my primary care physician?
Are specific diagnoses required for me to be reimbursed?
Does my plan limit how many sessions per calendar year I can have? If so, what is the limit?
Does my policy cover the following: a) Diagnostic interview (give them CPT code 90791); b) Individual therapy for up to 50 minutes (give them CPT code 90834); c) Teletherapy sessions (CPT code 90834 95)?
How much is the insurance company's "usual and customary fee" and what percentage do they cover? * This question will help you understand how much you may be reimbursed.
What percentage of my out-of-network mental health services will be covered if I submit a superbill? Is there anythin else I will need to submit with the superbill? How often should I submit a superbill, what is the process for submitting that and how long will it take for me to be reimbursed?
* After gathering this information, ask for a confirmation number and the name of the person giving you this information.*
Can I use my insurance benefits for therapy services?
A Superbill will be provided to you which you then submit to your insurance if you plan includes reimbursement for out-of-network psychotherapy services. A Superbill is essentially a receipt stating how much you were charged and what you have paid for therapy, and it also has some additional information that the insurance provider will want. This includes the Therapist license information, address of our office, and the "CPT code" that tells the insurance what kind of service you received.
There is no guarantee that your insurance company will reimburse you or not - which is why calling your insurance company directly prior to your first appointment is strongly recommended so that you can ask about your out-of-network benefits for mental health services.
Why Rachel Doesn't Take Insurance
Rachel believes that you should be able to grow and change in a safe and confidential space. Reason #1 - Client Confidentiality Insurance companies require therapists to use Electronic Medical Records system if we take insurance. The Department of Health and Human Services has recorded over 20,000 HIPAA violations that occur every year. Over time, if information is disclosed to a third party insurance or technology company, there is increased risk that your information is leaked. Additionally, if you or your child eventually need a federal background check, a diagnosis can be disclosed through your insurance company. Feeling safe and being able to open up in your therapy sessions is the biggest reason for change, and therefore your confidentiality stays between what you and your therapist discuss.
Reason #2 - You must have a Diagnosis In order to have insurance cover counseling, you must have a DSMV diagnosis. Even if it is not appropriate - there must be a diagnosis. And, this diagnosis stays on your permanent medical record. Rachel believes that everyone should have access to counseling, and that you should get help without having a diagnosis.
Reason #3 - Time is focused on YOU Completing paperwork for insurance reimbursement takes a great deal of time and energy. Each insurance company has it's own set of paperwork that a therapist must fill out to be included and then the process of billing the insurance and sending the appropriate documentation takes up even more time. The time that Rachel saves by not worrying about paperwork can instead be spent focusing on giving you the best possible care. Rachel's focus is on meeting the needs of her clients, not granting request of an insurance company.
Reason #4 - Insurance decides your treatment At the end of the day, insurance companies decide treatment. They determine the number of sessions and frequency. Rachel believes that it should be up to you both to decide this important factor. Sometimes you will need shorter sessions, or longer sessions. Maybe you need a session two times per week, or once a month. When an insurance company is involved, they dictate what they are willing to pay for so in effect someone who has never met you before is deciding whether or not they feel you need specific treatment. Clients should enjoy the freedom to choose what is best for their mental health, along with their therapist. When a client calls needing an emergency extra appointment - even through they have already had a session that week - Rachel can make an appointment without worrying about if insurance will cover it. If a client needs a 60 minute appointment versus the standard 45 minutes, you can talk about your needs with Rachel and make it happen.
Rachel will base your treatment on what you need - not what someone sitting in an office in another state feels like you should need. Rachel can make adjustments to your treatment quickly if something changes in your life. For example, say you are coming for anxiety treatment but suddenly lose your job and we need to switch gears to address your needs on loss and major life adjustments. Rachel wants you to get the best holistic treatment, period.
Investing in yourself - Your health is worth it!
Counseling is absolutely an investment into your personal growth and well-being. Think for a moment what a difference counseling can make in your life. How will life be different when you finish therapy? Envision yourself feeling more confident, more at peace, more clear in the direction you want to take your life. When you are feeling less stressed and making movement in your life consistent with your deepest values and highest best self, you will be more productive and not only mentally fit - but you will notice a positive effect on your physical health as well. Can you put a price tag on that emotional freedom?
You are worth investing in. Just like you want the best doctor when you have a physical illness, you want to find the right fit to treat your emotional and mental health concerns as well. But ultimately, you know your own needs and your budget best. If you have any questions, please do not hesitate to reach out and ask.
Fees & Payment
Rachel's therapy session rates are as follows: Intake appointment for Individual therapy: $150 (1.5 hours) Individual therapy session: $140-$170 (50 minutes)
Intake appointment for Couples therapy: $175 (1.5 hours) Couples therapy session: $185-225 (50-1.5 hours, based on treatment)
Intake appointment for Group therapy: $125 (45 minutes) Group therapy session: $70-90 (length of group and rate vary based on the group offering) Rachel accepts cash, check, Health Savings Account cards and all major credit cards as forms of payment. Additionally, Venmo and Paypal are also accepted. Checks can be payable to Rachel Pires, LCSW. Payment is expected at the time of service.
If you are unable to attend a session, please be sure to cancel with at least 24 hours prior to your scheduled appointment. You will be charged for the full rate of the session if you cancel with less than 24 hours notice. All no show appointments will be charted the full rate of the session. Life happens and there are times when you cannot make your appointment. However a cancelled appointment impacts three people: you, your therapist and another client who could have potentially used your time slot. When a session is cancelled without much notice, we are unable to fill this time slot by offering it to another client.
Please contact Rachel with any additional questions you may have - info@RachelPires.com