rates, INSURANCE & policies for therapy

SGS Practices is an out-of-network provider for therapy sessions. What this means is that if your insurance has out-of-network benefits for mental health services, you can submit a reimbursement form after completing and paying for your sessions. If you have out-of-network coverage, your insurance provider will send a check directly to you to cover part or all of the cost. Many patients are able to receive some reimbursement, typically ranging from 60%-100% of the cost of services.

Please note, mindfulness training, consulting, and executive and performance coaching are not reimbursable by insurance.

Before beginning therapy, it’s always best to call your insurance provider to learn more about your out-of-network benefits for mental health services. It’s usually most efficient to call the number on the back of your insurance card, though some member profiles will list the reimbursable rates. If you call, you can let the representative know that the we typically use the following CPT codes: 90971 (initial appointment only), 90834 (45-minute session), or 90837 (60-minute session). With that information, they should be able to estimate how much you’ll be reimbursed based on our rates.

Payment is due in full at the end of your session. However, once you complete your first session, a reimbursement form (i.e., Superbill) will be provided by SGS Practices via our secure portal. You will be able to submit that form directly to your insurance by using their portal, faxing it, or emailing it. Depending on your insurance provider, they will typically send the reimbursement check to you within 2-4 weeks. After your first session, SGS Practices will send subsequent reimbursement forms at the end of each month, though they can be generated more regularly if needed.

SGS Practices requires at least 48-hours notice if you need to cancel or reschedule an appointment. If you no show, cancel, or reschedule less than 48-hours before your session start time, the full session fee will be charged.

Your session time is reserved specifically for you. As such, SGS Practices asks you to arrive to your session at least 5 minutes early to make sure that we start on time. Oftentimes, another session may start when your session ends, so there won’t be time to run over. Please keep in mind that you will be charged the full session fee regardless of whether or not you arrive on time or end early.

Teletherapy, also known as virtual therapy or online therapy, is a form of psychotherapy that occurs online using a HIPAA-compliant video platform (similar to Zoom or Facetime). The sessions tend to be very similar to an in-person session, and research has shown that teletherapy sessions are just as effective as in-person therapy. Teletherapy also has the added convenience of allowing you to cut out any commuting time and be seen in the comfort of your own private space.

Most insurance plans will cover teletherapy (online/virtual therapy) in a similar way to how they cover in-person services. The insurance codes (see above for specifics) will be identical for in-person and virtual appointments, however, the location of the appointment will differ. It is best to check with your health insurance provider to ensure they cover telehealth appointments, so please make sure to ask when you call them about reimbursement rates.

In terms of seeing Dr. Samantha Gaies as a therapy patient, due to licensing laws, only patients who are physically located in New York State, Connecticut, or Florida (telehealth only) can schedule an appointment with SGS Practices. If you have questions, please contact us for more information.

Starting January 1, 2022, the government instituted a policy call the No Surprises Act. Under the law, health care providers need to offer patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

More specifically, this means you have the right to receive a Good Faith Estimate (GFE) in writing for the total expected cost of any non-emergency items or services. If you’d like a GFE prior to starting services, you are welcome to reach out to SGS Practices and ask for one.

If you want to learn more about the No Surprises Act and GFEs, please visit:

https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance