Insurance & billing

If a health insurance policy includes a deductible, then the insured must pay a certain amount of money toward his/her health care before the insurance company is required to pay anything under the policy. For example, if an insured has a $1,000 deductible toward his/her psychotherapy or testing services, then he/she is responsible for paying the first $1,000 of health care costs incurred. After he/she pays the first $1,000, then the insurance company will begin paying toward health care costs as specified under the terms of the policy. After an EOB (Explanation Of Benefits) is returned to PCPA confirming the amount to be applied towards the deductible, an invoice for the balance due will be sent to the patient.

A co-pay is a flat payment that is due at the time of a doctor visit, including treatment and testing. The co-pay is collected at the time of service and is the responsibility of the patient. A co-pay is processed at the time of service.

Like a co-pay, co-insurance is the responsibility of the patient. Co-insurance may represent 10% or 20% of the doctor’s fee that must be paid by the patient after meeting a deductible (if applicable). There is usually a maximum out-of-pocket limit, such as $1,000, $2,000 or higher that is the maximum a member can pay prior to the plan paying 100% during a calendar or benefit year. Copays, however, do not always count toward the out-of-pocket limit. Your co-insurance balance may not be known until an overall estimate of benefits is received. Therefore, co-insurance fees due will be billed sometime after time of service.

Most health insurance plans cover some level of therapeutic services. The amount of coverage you can expect will vary from plan to plan. In many instances, you'll have a deductible to pay before your services are 100% covered. We highly recommend that you contact your insurance customer support line prior to initiating services in order to find out more.

Payment for services received at PCPA is due on the day of service. Under certain circumstances, we may delay charging your credit card until your insurance plan communicates with us about their estimation of how much we are owed. We make every effort to expedite communication with your insurance. However, we do not control how long your insurance takes to process the claims, and may need to wait 4-5 weeks to charge you. We will never charge amounts over $500 to your credit card without consulting with you first.

Sliding scale fee for services may be available to patients who have out-of-network insurance plans depending on clinician availability. Sliding scale fee-for-service arrangements are typically limited to a certain number of visits.

You can contact billing@pcpachicago.com.

The primary reason that so many therapists don’t accept insurance is economic: rates of reimbursement by certain insurance companies are too low to sustain a profitable private practice. Working with insurance companies also involves significant paperwork, phone calls, and time spent dealing with claims denials and appeals. That is why, many therapists either choose to work with the highest reimbursement plans only, or do not accept insurance at all. Unfortunately, this decision has led to prohibitively high costs of mental health services, and reduced access to care for many people.

At PCPA, we have decided that restricting access to mental health services for the sake of profit does not agree with our ethical and moral standards. Limiting the types of insurance plans we work with would also severely diminish our capacity to work collaboratively with our physician partners. Over the years, we have found creative ways to compensate our staff fairly, while remaining in-network with the widest range of insurance plans possible, even when it does ultimately eat away at our bottom line.