Services

What to expect?

We start with an initial evaluation. This consists of a clinical interview to assess areas of concern and factors influencing these. We then work collaboratively to establish and prioritize treatment goals as well as the best therapeutic approach. Throughout the process of therapy, we continue to monitor progress and adapt treatment as necessary.

For children and teens participating in individual therapy, caregiver participation is essential to inform the initial diagnostic assessment. Ongoing parental involvement is determined by the age of the child and therapeutic need. Parent-only sessions may occasionally be recommended.

For individuals 18 years and older, involvement of family members or significant others in the diagnostic evaluation is at the discretion of the client.

For caregivers participating in SPACE to help their child/teen manage anxiety, therapy sessions would involve caregivers’ participation while tracking progress of their child’s/teen’s anxiety symptoms. In most cases, the child/teen does not need to attend treatment sessions.

Payment

Dr. Ahumada is out-of-network for all insurances. Payments accepted include: HSA, FSA, debit, credit, check, or cash. 

Many insurers cover 50-80% of the cost of out-of-network services, like outpatient therapy, but you will need to file for reimbursement after paying the full cost on the day of service. If you would like to go through your insurance for out-of-network benefits, please make sure to speak with your insurance carrier first to learn about your specific out-of-network coverage for mental health services. You can call the phone number listed on the back of your insurance card to ask:

•  Does my plan cover out-of-network providers for outpatient mental health? If so, what is the coverage?

• Does the out-of-network coverage apply to both in-person and Telehealth sessions?

• What is the Allowed Amount or UCR (Usual, Customary, and Reasonable Fee) for an out-of-network provider? (Some plans may cap the amount they allow, and reimburse based on this.)

• How much will I be reimbursed for intake appointments (CPT code: 90791) and for psychotherapy sessions (CPT code: 90837, 53+ minutes, most often used by Dr. Ahumada)?

• What is my out-of-network deductible and how much of it have I already paid this year? (The deductible is the amount you must pay yourself before the plan begins paying at all.  You may have a separate deductibles for in-network out-of-network providers.)

• When do benefits start and renew? (You will want to know when your deductible renews). 

• What is the Out-of-pocket Maximum? (The amount you must pay each year before the plan might starts paying 100% for health expenses).

• Are there any limits to the number of sessions per year?

• Do I need to be referred by an in-network provider, such as my primary care provider, in order to see an out-of-network therapist?

• How do I submit claims to the plan for reimbursement?  Do I need to get a form to attach them to?  What is the address where I would send MENTAL HEALTH claims? 

• Can you give me a Call Reference Number for this call?

You can also check your coverage by using a HIPAA compliant out-of-network reimbursement calculator, such as the Nirvana Reimbursement Calculator. However, note that this tool only gives you estimates on the amount of coverage and reimbursement you are eligible for. It is strongly recommended that you confirm this by contacting your insurance provider directly.

To make it easier for clients to submit claims to their insurance, if they choose to do so, Dr. Ahumada provides monthly statements (i.e., “Superbills”) that have all of the necessary information for clients to file with their insurance for possible out-of-network reimbursement.

There are also billing platforms designed to make it easier to submit out-of-network claims for reimbursement using the information from the superbill, such as Reimbursify, Mentaya, and Claimeye (note listing does not imply endorsement). If you are planning to file for reimbursement, please make sure to tell Dr. Ahumada that you will need superbills.

Notice of Good Faith Estimate:

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059.