Please note that we require 48 hours notice for cancellations. If late notice is given, you will be responsible for a $100 cancellation fee; we do not charge a fee for appointments cancelled due to medical or family emergencies.

Insurance benefits can be difficult to navigate.

As a practice, we believe it is very important for our clients to understand how their health insurance benefits work so they can make informed decisions and advocate for their own care. For this reason, I ask that you familiarize yourself with your policy details and contact your insurer prior to scheduling your initial appointment. A member of our team will assist in the event that there is any confusion and we always verify benefits before initial appointments. Ultimately, you are responsible for notifying us of any changes to your plan and for the balance any balance accrued due to non-payment by your insurance plan.

We are in-network with Cigna only. Some insurance or employee benefit plans offer out-of-network benefits.  It is up to you to determine whether this is the case for you, but your carrier will be able to provide this information via a phone call.  If you have an insurance plan with out-of-network benefits, we will provide you with a monthly invoice you can submit to your insurance plan for reimbursement. We accept most Aetna and UnitedHealthcare plans out-of-network and will provide an invoice you can submit to your insurer for reimbursement.

Before scheduling an appointment with any therapist, here are some questions to ask your insurer or HR department:

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If I am a Cigna member, are outpatient behavioral health visits covered under my policy? Are my behavioral health benefits covered under the same policy as my medical benefits? Do I need a referral from my primary care provider? Do I have an in-network deductible? What is my co-pay for outpatient behavioral health office visits?

Do I have out-of-network benefits? If so, do I have a deductible or co-insurance? What is the “usual and customary” or “allowed amount” for an out-of-network provider in my area? What is my “out-of-pocket maximum per calendar year”? By asking these questions, you can more accurately calculate your financial responsibility.

Other questions to ask: Is there a limit to the number of sessions I can receive in a calendar year? Does my plan cover telehealth (secure video or phone call)?

Here are some helpful terms and definitions:

  • Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)

  • Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible

  • Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

MAKING THE CASE FOR SINGLE CASE AGREEMENT (SCA) WITH INSURANCE COMPANIES


What is a Single Case Agreement (SCA)? A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network provider for a specific patient, so that the patient can see that provider using their in-network benefits (i.e., the patient will only have to pay their routine in-network co-pays for sessions after meeting their in-network deductible (if any)). The fee per session that will be paid by the insurance company is negotiated by the insurer and the provider as part of the SCA.

How do I initiate an SCA? Most plans prefer the client to call to initiate the SCA’ the provider will also need to speak with a representative from your insurer’s clinical team. The provider will need to spend time on the phone with a psychologist or other mental health provider from your insurance company, for something referred to as a “peer-to-peer” evaluation. At that point, if your provider authorizes an SCA, a contract will be sent to your therapist. We can then speak with you in greater detail about your financial responsibility, moving forward.

What are the conditions to be met to ask for a Single Case Agreement (SCA)? An SCA has to basically address the unique needs of the patient and the cost benefits to the insurance company of the patient seeing you, rather than an in-network provider. The following are some of the conditions that must be met for an SCA to be granted:

For a new potential patient:

 If you have had no luck finding an in-network provider with training and experience relevant to your specific clinical needs, then you can make the case for an SCA with the out-of-network provider BEFORE commencing treatment. 

  • If we have a clinical speciality that is not available with any of the in-network providers (speciality can include cultural competency)

  • Geographical location - in-network providers are not available locally

  • Treatment provided will keep the patient out of the hospital, or will reduce the cost of medications

For a current patient:

For a current patient who has obtained a new insurance, the main argument for the SCA would be to ensure Continuity of Care.

When can one make the case for Continuity of Care? If you recently changed insurance providers, then the insurance company can agree to a limited number of sessions (around 10) and period (e.g., 60 days since insurance change), to allow the patient to continue treatment with the current out-of-network provider, while transitioning to an in-network provider.

How does one negotiate the rates of payment and terms of the contract? If you are obtaining an SCA as a current patient for continuation of care, then the fee amount covered by your insurance plan will be based on your in-network coverage; your out-of-pocket costs should remain the same as if you were seeing an in-network provider.

Please note that Attune & Embody’s minimum rate for SCAs is $150 per 45 min session (90834) or $165 for 60 min session (90791). In the event that your plan is unwilling to meet this minimum fee, you may request a balance billing arrangement, in which the difference between our minimum fee and the SCA contracted rate is covered by the patient. Please speak with your insurance representative to determine whether this agreement is allowable.