Financial Information
Accepted Insurance Plans (In-Network)
Alex and Merging Rivers Counseling is “In-Network” with the following health insurance plans:
Aetna
Medica
Untied Healthcare (UMR/UBH)
Minnesota Medicare
Your responsibility for payment is determined by your specific plan. Alex is considered an “Out-of-Network” provider for all other insurance plans. As Alex is based in Minnesota but operates in several states, there has been a focus on accepting Minnesota based health insurance plans and national plans at this time.
National Plans - Untied Healthcare (UMR/UBH), and Aetna are the only national health plans accepted at this time. Some coverage variance exists across states, if you have one of these plans and are not located in Minnesota, please reach out to verify coverage prior to starting therapy.
Self-Pay Rates
The base rate for a therapy session (50 minutes) is $185/session. Each additional half-hour is $90.
You may choose to submit your bills to insurance for reimbursement under you out-of-network benefit. Your reimbursement will be based on the specifics of your plan and subject to your plan policies (such as deductible, and allowed rates). All private pay clients are welcome to utilize the Accessibility Pricing model below.
Accessibility Pricing
All self-pay clients are welcome to use the accessibility pricing model. When signing up for services, you will be asked to review your financial picture within the following analogy:
Full Cup - I can readily meet all of my financial needs
Mostly Full Cup - I can meet many of my financial needs
Partially Full Cup - I may struggle to meet all of my financial needs
Limited Cup - I regularly struggle to meet most of my needs
A more detailed example can be found here. Based on where one’s situation falls within these tiers determines what percentage of the base rate they pay for therapy services (between 25%-100%). The ability for Merging Rivers Counseling to support the lower ends of this model is capped to a few clients at a time but we are committed to serving anyone who needs it as much as we are able. We ask that client’s honestly reflect on their financial situation and respond truthfully so as to not take away our ability to help those with greatest need.
Payment Options - Pros & Cons
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Pros
You only pay your portion of the session fee as set by your insurance plan (co-pay or co-insurance).
What you pay is applied to your deductible and max out-of-pocket costs.
One of the more accessible ways to pay for therapy.
Cons
Requires you you have a qualifying Mental Health diagnosis according to the DSM5-TR.
Your plan may have a high deductible and you might need to meet it before insurance kicks in (meaning you pay 100% until the deductible is met).
Insurance can recoup what they pay at a later date (sometimes even years later), leaving you with a bill even after we are done meeting together. This is frequently called a "Claw Back”.
Generally, no coverage for services if you do not have a qualifying diagnosis or for certain services (such as couples counseling except in certain circumstances).
Cannot apply the accessible pricing model to insurance plans as their contracts require we charge the base rate and they negotiate a lower rate on your behalf.
-
Pros
Works like private pay when it comes to setting the fee structure.
You can work with us, even if we don’t accept your insurance plan.
No pre-approval or limit to how many sessions you are entitled to.
Cons
Your health insurance plan may have a high out-of-network deductible that could be difficult to reach.
Insurance plans very well may decline reimbursing you if they determine the sessions don’t meet their definition of necessity.
Like In-Network plans, they also require you to be diagnosed with a qualifying mental health disorder.
-
Pros
Enhanced Privacy, nothing leaves our systems unless you request.
No diagnosis required and no restrictions on treatment decisions, a truly personalized approach that doesn’t rely on insurance.
No chance of claw-backs.
Ability to use the Accessibility Pricing Model
You can access services insurance won’t cover like many forms of couples counseling.
Cons
Unless we are planning to use an out of network plan, you won’t be reimbursed for services.
A note about insurance and couples counseling
Health Insurance is first and foremost interested in treating mental health disorders. When it comes to generally improving quality of life, this is considered a personal investment and not under the umbrella of a mental health disorder.
Most insurance companies view couples counseling for the purpose of improving the quality of one’s relationship or someone’s quality of life as a personal investment, similar to a gym membership or massage. While things that enhance someone’s quality of life are valuable, most insurance companies do not see it as treating a mental health disorder, except in a few circumstances.
So when it comes to accessing couples therapy you essentially have two options:
We can use Insurance when...
One partner has a clearly diagnosed mental health disorder and couples therapy is focused on treating that
diagnosis.
Such as when:
A partner has PTSD and couples therapy will help reduce the trauma symptoms.
Couples counseling is an add on to one partner’s individual therapy for an established diagnosis.
Your insurance happens to cover standard couples therapy - some do!
Otherwise, private pay is available…
There are no restrictions when it comes to paying privately for couples therapy, and is an option for any couples believing they need the
extra support.
This applies when:
Neither partner has a diagnosable mental health disorder.
The focus of couples therapy is on something other than mental health symptoms.
Or you want to exercise more privacy when accessing services
Please reference the Accessible Pricing Model for Private Pay that is available.
