Insurance & Fees
Cedarhurst charges $225 for initial intake sessions and $195 for individual therapy sessions (53 minutes). The fees are the same for individual therapy and couples counseling, whether in-person at the office or over telehealth.
Self-Pay
Clients without insurance, or who prefer not to use insurance, are welcome to pay out-of-pocket at the rates listed above. No insurance information is required, and sessions are billed directly at the standard session fee.
Out-of-Network Insurance
If you have insurance for which Cedarhurst is not in network, you will be responsible for the full session fee at the time of service. You are still encouraged to contact your insurance company to ask about your out-of-network benefits — in some cases, plans will reimburse a meaningful portion of the cost. Upon request, Cedarhurst can provide a superbill to support this reimbursement.
Superbills
A superbill is an itemized receipt generated by a healthcare provider that contains all of the information your insurance company needs to process a reimbursement claim. It typically includes the provider’s name, license, and NPI number; the date of service; the relevant diagnostic code (ICD-10); the procedure code for the service rendered (CPT code); and the fee charged.
Superbills are most commonly used by clients who pay out-of-pocket at the time of service and then submit the receipt to their insurance company for partial or full reimbursement. This arrangement is sometimes referred to as using out-of-network benefits.
A few important things to understand about superbills:
- Reimbursement is not guaranteed. Whether and how much your insurance reimburses will depend entirely on your specific plan and its out-of-network benefits. Some plans reimburse generously; others do not reimburse at all.
- You pay in full at the time of service. Cedarhurst does not bill your insurance directly when a superbill is used. You pay the full session fee, and you are responsible for submitting the superbill to your insurance company and managing the reimbursement process.
- A diagnosis is required. In order to generate a superbill, Cedarhurst must assign a clinical diagnosis. If you have concerns about a mental health diagnosis appearing in your insurance records, this is worth considering before pursuing reimbursement through your insurance company.
- Contact your insurance first. Before your first appointment, call your insurance company and ask whether you have out-of-network mental health benefits, what percentage they reimburse, and how to submit a claim. This will help you understand what to expect.
Superbills are available upon request and will be provided in a timely manner following each session or on a monthly basis, whichever you prefer.
Using Health Insurance
Cedarhurst accepts the following commercial insurance plans:
- Highmark/Blue Cross Blue Shield
- UPMC (commercial plans)
- Aetna
Please note: Cedarhurst does NOT accept any Medicare or Medicaid plans, including Carelon, Community Care Behavioral Health (CCBH), UPMC for Life, UPMC for You, HealthChoices, Highmark Complete Blue, Highmark Wholecare, AmeriHealth Caritas, Aetna Better Health, Wellcare, Capital Blue Cross, or Anthem.
If you plan to use health insurance, your out-of-pocket cost per session will depend on the specific details of your plan. Health insurance plans vary widely, and it is common for patients to be uncertain about what their plan actually covers. The following is a brief overview of the most common cost-sharing arrangements.
Co-Pay: A co-pay is a fixed dollar amount you pay at the time of each appointment, regardless of the total cost of the service. For example, your plan might require a $30 co-pay for each therapy session, with your insurance covering the remainder. Co-pays are typically straightforward and predictable.
Deductible: A deductible is the total amount you must pay out-of-pocket for covered services before your insurance begins sharing the cost. For example, if your deductible is $1,000 and you have not yet met it, you will be responsible for the full session fee until that threshold is reached. Once your deductible is met, your insurance will typically begin covering a portion of each session going forward. Deductibles reset annually — usually on January 1st.
It is important not to confuse your deductible with your premium, which is the fixed monthly amount you pay to maintain your insurance coverage. Your premium is owed regardless of whether you use your insurance, and paying it does not count toward your deductible.
Co-Insurance: Co-insurance is a cost-sharing arrangement that kicks in after your deductible has been met. Rather than a fixed co-pay, co-insurance is expressed as a percentage. For example, if your plan has 20% co-insurance, you would be responsible for 20% of the session fee and your insurance would cover the remaining 80%. Co-insurance continues until you reach your plan’s out-of-pocket maximum, at which point your insurance covers 100% of covered services for the remainder of the year.
What This Means for Your Sessions Depending on your plan, you may have a co-pay, a deductible, co-insurance, or some combination of these. The only way to know for certain is to contact your insurance company directly. When you call, consider asking:
- Do I have a deductible, and how much of it have I met?
- Does my plan cover outpatient mental health services?
- Is Cedarhurst Psychological Services in network?
- What is my co-pay or co-insurance for outpatient therapy?
- Do I need a referral or prior authorization?
You are strongly encouraged to contact your insurance company prior to your first appointment to confirm your benefits. Cedarhurst will bill your insurance as a courtesy, but the patient is ultimately responsible for any balance owed.
Cancellation Policy
Cedarhurst requires at least 24 hours notice for appointment cancellations. Cancellations made less than 24 hours before a scheduled appointment are subject to a $50 late cancellation fee. This fee may be waived in circumstances involving emergencies, inclement weather, or if the appointment is rescheduled within the same week.
