Do you accept insurance?
Dr. Wenzel practices as an independent, out-of-network provider. Fees are payable at the time of service. You may wish to utilize out-of-network benefits that your insurance policy may cover (see below for more information).
Considerations in using insurance for mental health
Insurance companies require in-network providers to sign contracts that determine rates, number of sessions, and their right to determine or influence treatment planning. They routinely require the submission of session notes, diagnosis, supporting documentation, and treatment plans. Some policies will not cover marital or family/relational treatment. In-Network providers and their clients work with many restrictions.
When you pay out of pocket (or work with an out-of-network provider) you work in conjunction with your therapist to determine the course of counseling, the content, frequency and intensity. Details of your mental health information has a greater degree of privacy. In fact, if you pay entirely out-of-pocket, your information never leaves our office (except on rare occasions when required by law).
Reasons to pay out of pocket
By paying out-of-pocket you assure yourself and your family of the greatest degree of privacy. It gives you the maximum amount of flexibility, and your mental health information remains ‘off-the-grid’ so to speak. Your records remain free from insurance reporting or compliance audits. Additionally you have a wider range of providers, and are able to choose someone who has the experience you hope for, and can provide you with the quality of counseling you seek.
Billing Out-of-Network
If you determine that you do have out-of-network benefits, and you desire to use those benefits, there are two possible options: Dr. Wenzel can provide insurance billing through his practice (at no charge), or he can provide simple documentation (a super-bill) which you can submit to your insurance company yourself, for direct reimbursement. Out-of-network reimbursement is generally about 50-67% of what in-network coverage is.
In network example: The counselor’s fee is $160. As an in-network provider the automatically agree that the insurance company reduces their fee to $85.00, (taking a 45% reduction in fee/income) The client’s copay is $20, and the insurance company reimburses the counselor $65, for the total of $85.00
Out of network example: Dr. Wenzel’s fee is $160.00. He, or you, bills the insurance company out-of-network. The insurance company reimburses at 50%, or $80. Your payment is $80 per session.
To determine what benefits you might have, check your policy, or call your provider and seek answers to the following questions:
- Do I have mental health benefits?
- Is there a deductible, and has it been met yet?
- How many sessions per year does my policy cover?
- How much does my policy cover for an ‘out-of-network’ provider?
- How do I obtain reimbursement for an ‘out-of-network’ provider?
- Is approval required first?
Using your example, my fee would be $80 instead of $20. That is 4 times more. What are some thoughts about why I would want to do that?
You’ll need to decide what value to put on your therapy/counseling experience. We would encourage you to consider the following:
You are probably seeking help for something of great importance to you, i.e. your marriage, your kids, important relationship decisions, or mental health issues you are struggling with. These factors include much personal information. As mentioned above, out-of-network providers are better able to protect you health information and keep it private.
Additionally, as is true of much in life, you will get the value that you are willing to pay for. We encourage you to research and compare providers. Dr. Wenzel brings almost three decades of professional practice experience, 20 years of teaching, and a background that includes experience in a broad range of settings. Make sure you are getting your best value for your investment.