Payment.
Payment for services
As a private practice mental health counseling clinic, Pineapples Therapy has chosen not to be a part of any insurance panels. Our Pineapples Therapy clients pay us directly for services (out-of-pocket). We accept cash, check, HSA cards, and all major credit cards.
Pineapples Therapy providers then give clients a Superbill (a statement listing the dates, service codes and payments made) which the client can submit for reimbursement to their insurance company for out-of-network benefits. Most of these plans have a high deductible to be met, before any out-of-network benefits take effect. We encourage you to contact your insurance provider for details about your specific plan benefits.
Privacy is one of those fundamental human rights that’s quickly becoming a thing of the past. But it doesn’t have to be—especially in our office. While all therapists adhere to HIPAA standards and take care to protect a client’s confidentiality, there’s someone they can’t guard from when they accept a third party payer, and that’s the third party payer.
When you and your therapist go through a third party payer, a little bit of that confidentiality is compromised. The third party payer, whether a private insurer or a public program, can learn sensitive information about you, the client. You may not want that information shared. Because we do not accept insurance, that is never an issue at Pineapples Therapy.
However, we understand that private pay is not an option for every client. We encourage you to talk with your insurance provider and ask about getting a “Single Case Agreement” between Pineapples Therapy and your provider.
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 insurance company and the provider as part of the SCA.
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 the out of network provider (Pineapples Therapy), 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:
You have a clinical specialty that is not available with any of the in-network providers (one such specialty at Pineapples Therapy is that our clinical director is a Registered Play Theraist)
Geographical location - in-network providers are not available locally (this can also include long waiting lists with in-network providers)
Treatment provided will keep the patient out of the hospital, or will reduce the cost of medications
If the client has had no luck finding an adequately skilled in-network provider, then the client makes the case for an SCA with the out-of-network provider BEFORE commencing treatment.
How does one negotiate the rates of payment and terms of the contract?
One thing to keep in mind is that insurance companies are legally obligated to provide clients with adequate treatment by properly trained professionals. Therefore, if the insurance plan does not cover any out-of-network services, AND there are no in-network providers with the given specialty, then we at Pineapples Therapy may be able to negotiate our full fee as the session rate for you as a new client. This is because the client is not simply choosing to come to Pineapples Therapy, but is being forced to, due to inadequate in-network provider availability.
