Paying for Therapy

Clear steps for inquiring about Out of Network Benefits, a “script” for calling your insurance company and accessing the Slide Fee Scale

Out of Network Benefits

Even though I do not bill insurance directly, most of my clients still use their insurance benefits.

I am considered an Out-of-Network (OON) provider. Many health insurance plans have OON benefits that can reimburse you for 50%–80% of the session cost after you meet your deductible. You can also use your HSA or FSA card for all payments.

You can use the Free Thrizer widget below to find out what your insurance provider for OON benefits for therapy.

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I don’t want to use the Free Thrizer Widget above…

How else can I find out about Out of Network Benefits?

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Pre-Call Checklist

  • Get your insurance card ready.

  • Call the member services number on the back of your card.

  • Have the following details ready about your provider:

    • Provider's full name and address. Melanie Bouchard 75 Talcott Rd Suite 50 Box #54 Williston VT 05495 Licensed Psychologist Master

    • Provider's tax ID number or NPI number. NPI: 1164180550 Tax EIN: 41-2517128

    • CPT code(s) for the procedure:

      • All first “intake” sessions are 90791

      • Individual sessions: 90837

      • Family & Couples: 90847 

    • The fee per session

      • Intakes & Individual Counseling: $180

      • Couples/Family Therapy $200

  • Have a pen and paper ready to record the representative's name, date, and call reference number. 

Need a Script for the Call?

You: "Hi, I’d like to verify my out-of-network benefits for outpatient mental health counseling/therapy services with a provider who is not in your network."

Rep: (Verifies identity)

You: "I have a few specific questions about my plan's coverage for an out-of-network provider."

1. Do I have out-of-network benefits?

  • If no: Ask if they have any exceptions for when no in-network provider is available.

  • If yes: Continue. 

2. What is my out-of-network deductible?

  • "What is my OON deductible for the year? How much of that deductible have I already met?"

3. What is my coinsurance?

  • "Once I meet my deductible, what percentage of the cost will you cover?" (e.g., 50% or 60%)

4. What is the 'Allowed Amount' for the procedure?

  • "The provider charges $180 / session,  can you tell me the 'Allowed Amount' or the 'Usual, Customary, and Reasonable' (UCR) fee you use for {CPT code (see above)} in my area?".

    • Note: Insurance reimburses based on their allowed amount, not the provider's charge. 

5. How do I submit a claim?

  • "How do I submit a Superbill? Is there an online portal for submissions or a mailing address 

6. Do I need a referral?

  • "Do I need a referral from my primary care physician to see an out-of-network provider?"

Important Tips

  • Keep Records: Ask for the call reference number and the name of the representative.

  • Ask for an Email: Ask them to send the benefit information via email to confirm.

Reduced-Fee Appointments

Wayfinder Counseling VT maintains a limited number of reduced-fee appointments for clients for whom the standard private-pay fee would create a financial hardship.

Reduced-fee appointments are offered based on financial need and availability within the practice. Formal income documentation is not required.

If a reduced-fee appointment is available, the agreed-upon fee will be discussed and documented before services begin. Reduced-fee arrangements may be reviewed periodically and may change if financial circumstances, service needs, or practice availability change.

Please contact Melanie at Melanie@WayfinderCounselingvt.com to inquire about availability.  

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Ready to get the support you need?

Schedule a free 15-minute consultation so you can tell me a little about what has been happening, ask questions, and get a sense of whether working together feels like a good fit.

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Wayfinder Counseling VT is not a crisis service. If you or someone you know is in crisis, please call or text 988- the Suicide and Crisis Lifeline or in an emergency call 911.