Insurance Information

We currently accept most plans from the insurance shown above  on an in-network basis. We always recommend you call your insurance to verify your coverage and determine if you have a co-pay. You can check the back of your insurance card for the contact information. Your insurance card usually lists your co-pay as well.

A note about Tricare 

• Tricare Prime users are required to obtain a referral authorization from your Primary Care Manager (PCM).  The referral must specify the referral is to One Therapy and Consulting. However, Tricare may or may not authorize this referral. The referrals are usually processed by Tricare within 2-3 business days and One Therapy and Consulting will be notified electronically. Once an authorization is received, we will contact you within 2 business days, usually much sooner. 

• Tricare Select users do not require a referral authorization. 

We currently accept Tricare as a non-network participating provider. You are encouraged to  visit this link to get more information: TRICARE East Non-Network Providers (humana-military.com).  Prime members who have a referral receive coverage on an in-network basis. 

We do not accept Medicare as primary or secondary insurance at this time. We do not accept these Medicaid plans: AmeriHealth Caritas Medicaid, UnitedHealthcare Medicaid, or Carolina Complete Health Medicaid.

If you don't see your insurance company shown above, you can still receive services. You will be asked to pay at the time of services, and we will provide you with a receipt you can submit to your insurance company. Some insurance companies will reimburse you for part of the bill for services you received on an out-of-network basis. We encourage you to ask your insurance company about out-of-network benefits.

You may want to ask these questions when you call your insurance: 

• Do I have mental health insurance benefits?

• When does my plan period start and end? 

• What is my deductible, and has it been met?

• How many sessions per year does my health insurance cover?

• What is the coverage amount per therapy session?

• Do my insurance benefits cover telehealth sessions?

• Is approval required from my primary care physician?

It's always worth calling your insurance company to get the details. 

One Therapy and Consulting reserves a limited number of sessions for individuals who lack insurance and ability to pay out of pocket. Please give us a call to discuss qualifying for a sliding scale fee.  

We do not accept Medicare as primary or secondary insurance at this time. We do not accept these Medicaid plans: AmeriHealth Caritas Medicaid, UnitedHealthcare Medicaid, or Carolina Complete Health Medicaid.

One Therapy will do our best to verify your insurance information. 

It is the client's responsibility to know what is covered by their insurance policy. We know it can be confusing. Not sure what all these insurance words mean? Check out the Common Insurance Words Defined. 

You may want to ask these questions when you call your insurance: 

• Is One Therapy and Consulting in-network? 

• Do I have mental health insurance benefits?

• What is my deductible and has it been met?

• Do I have a co-pay and how much is it?

• How many sessions per year does my health insurance cover?

• What is the coverage amount per therapy session?

• Do my insurance benefits cover telehealth sessions?

• Is approval required from my primary care physician?

• Can I get reimbursed if I use an out-of network provider? 

• How much of the fee is reimbursed for out-of-network providers?

• How do I submit for reimbursement if I use an out-of-network provider?

It's always worth calling your insurance company to get the details. 

Claim - A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.

Copayment or Copay- A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible. 

Let's say your health insurance plan's allowable cost for a doctor's office visit is $100. Your copayment for a doctor visit is $20.

• If you've paid your deductible: You pay $20, usually at the time of the visit.

• If you haven't met your deductible: You pay $100, the full allowable amount for the visit.

Coinsurance - The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.

• If you've paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.

• If you haven't met your deductible: You pay the full allowed amount, $100.

Deductible - The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

Dependent - A child or other individual for whom a parent, relative, or other person may claim a personal exemption tax deduction. Under the Affordable Care Act, individuals may be able to claim a premium tax credit to help cover the cost of coverage for themselves and their dependents.

Excluded services - Health care services that your health insurance or plan doesn’t pay for or cover.

Open Enrollment - The yearly period (November 1 – January 15) when people can enroll in a Marketplace health insurance plan.Outside Open Enrollment, you may still be able to enroll in Marketplace coverage if you have certain life events, like getting married, having a baby, or losing other health coverage, or based on your estimated household income. Job-based plans may have different Open Enrollment Periods. Check with your employer.

Out of pocket maximum - The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

Qualifying Life Event - A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. There are 4 basic types of qualifying life events. (The following are examples, not a full list.)

Loss of health coverage

• • Losing existing health coverage, including job-based, individual, and student plans

  • Losing eligibility for Medicare, Medicaid, or CHIP

  • Turning 26 and losing coverage through a parent’s plan

Changes in household

• • Getting married or divorced

  • Having a baby or adopting a child

  • Death in the family

Changes in residence

• • Moving to a different ZIP code or county

  • A student moving to or from the place they attend school

  • A seasonal worker moving to or from the place they both live and work

  • Moving to or from a shelter or other transitional housing

Other qualifying events

• • Changes in your income that affect the coverage you qualify for

  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

  • Becoming a U.S. citizen

  • Leaving incarceration (jail or prison)

  • AmeriCorps members starting or ending their service

This information and more is available from Healthcare.gov. 

If you are looking for insurance, visit Healthcare.gov for help. You can start an application, review plans, or get local help finding just the right plan for you.