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Insurance Information

A Brief Guide to Using Your Mental Health Coverage.

We understand insurance can be confusing for some and we will try to help you navigate the process.

At this time PNPG  accepts and participates IN-NETWORK with the following plans:

  • Highmark PPO

  • Capital Blue Cross PPO (NOT KEYSTONE CENTRAL NOR NEW ST. LUKE'S CAPITAL)

  • Populytics and Valley Preferred-LVHN

  • Most State Based and Federal Blue Cross/Blue Shield Plans

  • Cigna PPO 

PLEASE BE ADVISED we NO longer participate with the Amerihealth Administrators, Independence Administrators (IBX), Magellan Networks Associated with the St. Luke's Hospital and Independence Blue Cross Blue Shield Plans.

 

As a patient at PNPG you are responsible to:

  • Verify your mental health coverage is in-network with PNPG as a group. WE will not verify this for you.

  • Pay your co-pay or co-insurance at time of service. Initially, if there is confusion we will general submit a claim to verify this.

  • You will be required to store your payment information in our secure encrypted platform, Simple Practice Portal. 

  • Be aware of specific plan limits, pre-authorizations, referrals required and deductibles. Please contact your carrier for your eligibility and benefits prior to reaching out for an appointment.

  • Deductibles MUST be met (IE you pay out of pocket) before accessing your benefits. These deductibles can be individual or family and can be upwards of multiple thousands of dollars depending on the plan you chose.

  • Please remember to verify PNPG is an IN-NETWORK provider as your MENTAL HEALTH/BEHAVIORAL benefits. At times major medical companies will "carve out" mental health benefits to another carrier and you will not be covered.

 

At this time we do NOT participate with AETNA, UNITED BEHAVIORAL HEALTH, UNITED HEALTH CARE, UPMC, MEDICARE, MEDICAID or any other MAGELLAN Health Plans.

 

Your provider can provide documentation of services in the form of a super bill for self-submission for potential out-of-network reimbursement. However, we cannot submit these claims for you.

 

We DO accept private/self pay at a discounted rate, which varies by provider. This fee can range from 105-175 per session.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your  medical and mental health 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 expected charges for medical services, including psychotherapy services. 

 

You have the right to receive a Good Faith Estimate for the total expected cost of 

any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 https://www.cms.gov/nosurprises.

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