​1. Consult with Your Insurance Provider

• Contact your insurance company: Start by calling the customer service number on the back of your insurance card.
• Inquire about SCAs: Ask if your insurance company offers SCAs for faith-based counseling services.
  
  

2. Gather and Submit Necessary Documentation

• Referral from your doctor: Some insurance companies may require a referral from your primary care physician.
• Letter of medical necessity: Obtain detailed letters explaining the necessity of the counseling services from both your counselor and your doctor. These should include:
  • A clear reason for the counseling services.
  • Explanation of how the services address specific mental, emotional, and/or spiritual needs.
  • Justification for why pastoral or faith-based counseling is imperative.
  • Explanation of the pastoral counselor's credentials from the pastoral counselor.
• Submit the detailed letters to your insurance company.
  
  

4. Follow Up

• Regular communication: Maintain regular contact with your insurance company to check the status of your request.
• Advocate for your needs: Be prepared to explain why these services are essential for your well-being.
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Tips for a Successful Request

• Be specific: Clearly outline why faith-based counseling is necessary for your care.
• Be persistent: Follow up regularly and be prepared to provide additional documentation if needed.
• Seek support: Your counselor and your doctor can be strong advocates, providing necessary information and backing up your request.
  
  

If Your Request is Approved
Once your single-case agreement (SCA) is approved, you can begin your counseling sessions with peace of mind, knowing that your insurance will cover the costs. Here’s what you can expect:

• Direct Billing: Your counselor will bill your insurance company directly for the approved sessions under the SCA. This means you won't need to handle the billing process yourself.
• Insurance Payments: The insurance company will process the payments according to the terms of the SCA, covering the agreed-upon costs.
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Disclaimer: The information provided here is intended to help you understand the process of securing a single-case agreement (SCA) for pastoral counseling services. However, we cannot guarantee that following this guidance will result in coverage, as each insurance company has its own policies and criteria. We cannot guarantee any outcomes on behalf of any insurance company. For the most accurate and personalized information, please contact your insurance provider directly.

At Prism Counseling & Coaching, we strive to make our specialized services as accessible as possible. While we do not directly bill insurance, you may be able to receive reimbursement for our services through your out-of-network (OON) benefits by submitting a superbill. Here’s a step-by-step guide to help you navigate this process.

What is a Superbill?
A superbill is a detailed receipt provided to you after your sessions, which includes all the necessary information your insurance company needs to process a claim for reimbursement. This document contains service dates, descriptions, and the necessary procedural and diagnostic codes.

Steps to Submit a Superbill

1. Check Your Insurance Benefits
   Contact your insurance company to verify your out-of-network (OON) benefits. Ask them about the reimbursement process for out-of-network services and what documentation is required. Inquire about any deductibles, co-insurance, and maximum reimbursement limits.
2. Receive Your Superbill
   After each session, we will provide you with a superbill via Simple Practice. You will receive an email notification when the superbill is available in your client portal. This document will include the service date, description, and the fee for each service.
3. Prepare Your Claim
   Gather all the necessary documentation as specified by your insurance company. This typically includes the superbill and a claim form provided by your insurer. Fill out the claim form accurately, ensuring all details match the information provided on the superbill.
4. Submit Your Claim
   Submit the completed claim form and the superbill to your insurance company. This can usually be done via mail, fax, or online submission through your insurance provider’s website. Keep copies of all documents submitted for your records.
5. Follow Up
   After submitting your claim, follow up with your insurance company to confirm receipt and check the status of your claim. Be sure to note any reference numbers or contacts you speak with for future reference.
   
   

Important Considerations

• Payment Upfront: You are required to pay for our services upfront. After payment, you can then submit the superbill to your insurance company for potential reimbursement.
• Insurance Coverage: While we provide the necessary documentation, we cannot guarantee reimbursement. Coverage for specialized services such as pastoral counseling (or faith-based counseling) and other services we provide, such as personal training and health coaching, varies by insurance plan. It’s essential to verify your coverage and understand that reimbursement is subject to your insurance provider’s policies.
• Pastoral Counseling Licensure in Arizona: In Arizona, there is no option for licensure for pastoral counselors like there is in other states. Some insurance companies will still cover pastoral counseling if providers are certified (which we are) and there is a clear reason for care. It is important to advocate for the necessity of the counseling services you receive by explaining how they address specific mental, emotional, and/or spiritual needs.
• Partial Reimbursement: If your claim is approved, reimbursement may only be partial as any copays and coinsurance may be deducted. However, it’s worth a shot, as some clients prefer to see if they can recoup some costs. Knowing that this is an option can be reassuring.

What to Do If Your Claim is Denied
If your insurance company denies your claim, don’t be discouraged. There are steps you can take to appeal the decision:

1. Request a Reason: Ask your insurance company for the specific reason(s) your claim was denied. This information will help you understand what needs to be addressed in your appeal.
   
2. Submit an Appeal: Write a formal appeal letter to your insurance company. Include the superbill, the initial claim form, and any additional documentation that supports the necessity and appropriateness of the services provided.
   
3. Supporting Documentation: We can provide additional letters and documentation to support your appeal. This might include detailed descriptions of the services provided and how they relate to your overall well-being. Additionally, having your doctor indicate that counseling is needed can significantly strengthen your appeal. Some insurance companies have reimbursed for pastoral counseling if it is prescribed by a doctor, though policies can change frequently.
   
4. Follow Up: After submitting your appeal, follow up with your insurance company to confirm receipt and check the status of your appeal. Keep detailed records of all communications.
   
5. Consultation: Sometimes, speaking directly with a representative from your insurance company can help clarify misunderstandings and provide further insight into what is needed for a successful appeal.
   
   

Navigating the insurance reimbursement process for pastoral counseling and other specialized services can be challenging, but we are here to support you every step of the way. By understanding your out-of-network benefits, preparing and submitting superbills, and following up diligently, you can enhance the likelihood of receiving partial reimbursement.

​Remember, persistence and thorough documentation are key. If your claim is denied, don't be discouraged; we can assist with appeals and provide additional supporting documentation. Always keep detailed records and consider consulting additional resources or patient assistance programs if needed.

If you have an HSA (Health Savings Account) or FSA (Flexible Spending Account), you can use these funds to cover the cost of your sessions at Prism Counseling & Coaching. HSAs and FSAs are special accounts that allow you to set aside pre-tax money to pay for qualified medical expenses, including counseling services. Here’s how using your HSA or FSA card can benefit you:

Tax Efficiency
Using your HSA or FSA card to pay for counseling services can be a tax-efficient way to manage your healthcare expenses. By utilizing pre-tax dollars, you effectively reduce your taxable income, which can result in significant tax savings.

Flexible Payment Options
Whether you are paying per session or taking advantage of our discount packages, you can use your HSA or FSA funds to cover the costs. This flexibility allows you to choose the payment method that best suits your financial situation and therapeutic needs.

Coverage for All Session Types
Your HSA or FSA card can be used to pay for all types of sessions offered at Prism Counseling & Coaching, including individual sessions or discounted packages.
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Important Considerations Regarding Privacy
While using your HSA or FSA card offers many benefits, it is important to note the potential impact on your privacy. When you use these accounts, your records may need to be disclosed to third parties. This process can potentially compromise the full privacy of your records to facilitate reimbursement.

No Insurance Limitations

• Unlimited Sessions: Private pay clients are not subject to the limitations often imposed by insurance companies on the number of sessions allowed. You can attend as many sessions as you need without worrying about coverage caps.
• No Treatment Restrictions: Insurance companies may restrict the types of therapy covered. With private pay, you have the freedom to choose the therapy modalities that work best for you, without any limitations.

Personalized Care

• Tailored Treatment Plans: Our counselors can create highly personalized treatment plans tailored specifically to your needs, without having to align with insurance requirements or criteria.
• Enhanced Therapeutic Relationship: Without the constraints of insurance documentation and approval, our counselors can focus more on building a strong therapeutic relationship, providing you with a more supportive and effective counseling experience.

Immediate Access

• No Waiting Periods: With private pay, you can often get quicker access to services without the need for lengthy approval processes that are typical with insurance companies.
• Flexible Scheduling: You have greater flexibility in scheduling sessions that fit your lifestyle and commitments, ensuring you receive timely and convenient care.

Transparency and Control

• Clear Pricing: Our pricing structure is straightforward and transparent, allowing you to understand the costs upfront without hidden fees or unexpected expenses.
• Direct Communication: You can communicate directly with your counselor regarding your treatment, appointments, and payments, without intermediary delays or miscommunications often experienced with insurance companies.

Focus on Wellness, Not Diagnoses

• Holistic Approach: Private pay allows for a more holistic approach to your mental health and wellness. You and your counselor can work on a wide range of issues without needing to fit your situation into a specific diagnosis for insurance purposes.
• Preventive Care: You can seek counseling for preventive care and personal growth, addressing issues before they become more serious, which is often not covered by insurance.​

​Choosing private pay at Prism Counseling & Coaching empowers you to take charge of your mental health journey, ensuring you receive the best possible care tailored to your unique needs. If you have any questions or need assistance, our team is here to help you navigate your options and make the best choice for your well-being.