The Triumph Center for child, adolescent, and young adult counseling participates with Blue Cross Blue Shield (BCBS), United Healthcare (UHC), Harvard Pilgrim Healthcare (HPHC), MassGeneral Brigham Health Plan, and commercial Tufts Health Plans for behavioral health services. Participation with insurances may change. It is important to understand your mental health care coverage so that you can be an active advocate within the guidelines of your particular plan. A telephone number for Behavioral Health is located on the back of most insurance cards. Prior to your first appointment, we encourage our clients to call this number and inquire about outpatient mental health benefits.

There are typically three types of insurance plans. Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Point of Service Plans (POS). Plans are subject to co-pays, calendar year deductibles, co-insurance, authorizations and visit limits.

Please be aware of our policies regarding group therapy when making decisions about insurance. Unless otherwise indicated, a minimal commitment of one fourteen-week group session is required for all new clients and co-payments are billed in advance. We cannot bill the insurance company for missed sessions and all absences and/or change of coverage will be the financial responsibility of the client, parent and/or guardians.

If you do not participate with our accepted insurance plans and can utilize out of network mental health services, we will provide you with a detailed invoice to submit to your mental health provider and if approved, will reimburse you directly.

Frequently Asked Questions about Benefits

Q: Will insurance cover the cost of group and other counseling services?

A: Health insurance polices typically cover mental health services under guidelines that refer to medically necessary services. This usually means coverage for a mental health problem that has been formally diagnosed. Health insurers do not necessarily pay for all of your health care costs; they pay for covered services according to your specific plan. Co-pays, co-insurance, missed sessions and deductibles are your financial responsibility. Please check your coverage before making decisions to seek counseling services.

Q: Do I need pre-authorization for office visits?

A: Since most HMOs require pre-authorization, you should contact your insurance company by calling the toll free number. Preferred Provider Organizations (PPOs) may or may not require pre-authorizations. Once the original authorization has been used, the therapist may be required to submit a form explaining why more sessions are needed. This often requires sharing some confidential information about your problems and describing the plan for resolving those problems.

Q: Are there advantages to paying out-of pocket for counseling services?

A: There are a number of advantages to paying for your own counseling, although there will likely be greater financial costs to you. Confidentiality is one reason to consider paying for your services out-of-pocket. When using your insurance, personal information is given to the insurance company which is entered into a national data bank and the information is handled by various insurance company employees. Also, some insurers attempt to have a more active say in your treatment plans. Finally, if you are paying out-of-pocket, then you can see whomever you want and at whatever frequency you and your counselor decide is in your best interest.

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost

• Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (617) 573-1600