Frequently Asked Questions

During your first appointment, your therapist will gather information about you and your current and past emotional health, discuss your therapy goals, and address any questions or concerns you have regarding therapy. The first appointment is typically 75 minutes to ensure your therapist gains a deeper understanding of your personal history, concerns, and goals.

Cognitive Behavioral Therapy (CBT) is a structured, solutions-oriented, and evidence-based type of psychotherapy. CBT focuses on your thoughts and behaviors and how the two affect your mood. By identifying and assessing your thoughts, you can adopt healthier thinking patterns to relieve your symptoms and improve the way you feel significantly.

Please click here to learn more about CBT or the benefits you can expect from treatment.

Appointments are available Monday through Saturday from 9:00 am to 9:00 pm. Some therapists may offer availability in addition to the days and times listed to make your appointments as convenient as possible. Please let our care coordinators know your preference, and we will do our best to schedule you with the best fit.

We are out-of-network with most insurance providers, so we do not accept insurance payments. The total fee for our services must be paid in full at the time of the appointment.

Many of our services may be eligible for reimbursement if you have out-of-network benefits. To help process claims, we can provide you with a superbill, which includes all the necessary information to submit claims to your provider, or we can submit claims on your behalf for your convenience. While payments are made directly to us by you, any reimbursement from your insurance provider will be made payable and issued to you.

Our billing team would be happy to verify and review your out-of-network benefits with you before scheduling your initial appointment.

Insurance FAQ’s

The following information was created by Palo Alto Therapy to provide clients with helpful information regarding health insurance benefits and claims. The information below is accurate to the best of our knowledge, however we recommend verifying this information directly with your insurance company.

Please remember if you have out of network benefits, many of Palo Alto Therapy’s services may not be reimbursable for a variety of reasons, including but not limited to the following: specific diagnosis, length and/or frequency of sessions, location and/or delivery of services, etc. 

We do our best to recommend and provide the best care regardless of what your insurance may or may not cover as providing quality, evidence based therapy is our main focus. 

What is an out-of-network provider?

An out-of-network provider is a provider that does not have a contract with your health insurance company to accept certain negotiated rates. Most high level mental health providers in the Bay Area are out-of-network providers given the low rates that insurance companies provide and the difficulties that can come with contracting directly with insurance companies.

What is a deductible?

A deductible is a specified amount of money that you must pay before your health insurance company will begin to cover the costs.

What is coinsurance?

After your deductible is met, your health insurance company begins paying a percentage of the cost of your care. The percentage that you pay is your coinsurance. For example, under a 70/30 coinsurance plan, you are responsible for 30% of the cost and your insurance company will pay the remaining 70%. Please refer to usual, customary, and reasonable rates and allowed amount for more information. 

Please Note: Payments for Palo Alto Therapy services are the responsibility of the client regardless of whether your deductible or out of pocket max is met as we do not contract directly with most insurance companies.

What is an out of pocket maximum?

An out of pocket maximum is the maximum amount of money you have to pay for covered services in a plan year. After the out of pocket maximum has been reached, your health insurance company will pay 100% of the costs of covered benefits. 

What are CPT codes?

Common Procedural Technology (CPT codes) are numbers assigned to services provided to a patient including medical, surgical, and diagnostic services.

CPT Codes Palo Alto Therapy Frequently Uses:

90791: Initial Visit (60-75 minutes) 

90832: Individual Psychotherapy (30 minutes)

90834: Individual Psychotherapy (45 minutes)

90837: Individual Psychotherapy (60 minutes)

90847: Family Therapy w/ patient (45-75 minutes)

90846: Family Therapy w/o patient (45-75 minutes)

What is prior authorization?

Certain services may need approval from your health insurance plan before they are covered. (Prior authorization is also referred to as “pre-authorization”.)

What is telehealth?

Telehealth is the distribution of health related services and information via phone or video.

What are usual, customary, and reasonable rates?

Usual, customary, and reasonable rates (UCR) are health care prices that are based on the commonly charged or prevailing fees for health care services in a geographic area. Health insurance plans determine the UCR rates for all services and do not pay charges that exceed the UCR rate. The UCR amount is sometimes used to determine the allowed amount. In our experience, the UCR amounts are well below average for our type of quality mental health services.

What is an allowed amount?

The maximum amount a health insurance plan will pay for a covered health care service. If the allowed amount is greater than the amount charged you may have to pay for the difference. 

What does coordination of benefits refer to?

If you have two health insurance plans, they may work together to pay claims for the same service. Coordination of benefits is the process of determining which health insurance plan will have the primary responsibility of processing and paying the claim. 

How does claims processing work?

Palo Alto Therapy submits claims electronically to most insurances twice a month. A claims processor then reviews the claim to determine if additional information is required, and notifies you and/or the provider if additional information is required. Next, the claims processor determines whether the service you received is covered. Claims can take about 30-45 working days to review. If the service is covered, your insurance company will pay the claim, but depending on your benefits it may be the entire cost or a portion of the cost. 

When can I expect to receive reimbursement from my health insurance company?

After a claim has been submitted and processed, and if your health insurance plan has a deductible, after your deductible is met, your health insurance company may begin paying a percentage of the cost of your care. 

Any reimbursement approved by your insurance will be sent directly to you. In some instances, we receive insurance reimbursements payable directly to Palo Alto Therapy in error, if this occurs, rest assured that we will contact you to make arrangements for you to get these payments.

What does “medical necessity” or “medically necessary” mean?

Health insurance companies provide coverage for services deemed medically necessary. The criteria for services deemed medically necessary may vary based on the insurance provider. Generally medical necessity or medically necessary refers to “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”

While services you receive may not be deemed medically necessary by your insurance provider this does not mean that you are not struggling nor does it mean that therapy will not help you. 

What are common reasons for denied claims?

1. Treatment sought without prior authorization
2. Improper claim filing (missing information)
3. Claims not filed within timely filing limit
4. Treatment not covered by the insurance policy
5. Procedure deemed medically unnecessary

The cost of therapy typically ranges between $165 and $295 per 45-minute session. Some factors that affect the price of therapy include the therapist’s training and experience, the length of the therapy session (we offer various session lengths to best suit your needs), and more.

You will be notified of any fee increase at least 30 days before the effective date.

 

Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your care will cost. At Palo Alto Therapy, your costs are clear, as you pay per appointment based on the length of each appointment. Your total cost of services will depend upon the number of therapy sessions you attend. You are encouraged to speak with us anytime about the Good Faith Estimate. Please find more information about Good Faith Estimates here.

Our therapists have extensive experience treating anxiety-related conditions, including panic, phobias, and stress, as well as depression, family issues, grief and loss, OCD, parenting, PTSD, relationship issues, sexuality, significant life transitions, trauma, and much more.

We work with children ages four and up, teenagers, and adults of all ages. We provide individual therapy, family therapy, couples therapy, as well as group therapy and support groups.

It depends. While Cognitive Behavioral Therapy is generally considered short-term therapy due to its solutions-focused approach, every individual is unique. Many clients notice improvements within a few sessions, while others may need more support. Various factors may also affect how many sessions are right for you, such as the length of your appointments, your treatment goals, your level of motivation, the amount of effort you are willing to put forth, and more.

Although it is difficult to predict exactly how many appointments you will need, you and your therapist will collaborate to set a treatment plan and discuss how many appointments may be the most beneficial for you. If you want to learn more about your role in the therapeutic process, please read the following articles: How to be Successful in Therapy and Is Palo Alto Therapy Right for You.

Yes. All of our therapists provide video or phone therapy.

We require 24 hours’ notice to avoid being charged for the full session. Please get in touch with our care coordinators or your therapist to cancel your appointment.

We do not prescribe medication. However, we work closely with psychiatrists and can give you a referral to a psychiatrist, who may prescribe medication as necessary. Often therapy is effective without medication, but we are happy to discuss other options with you.