 Thalia's Fees and Insurance Participation
The fee for one 50 minute session of therapy is $85.00. If you have insurance coverage, this is the amount that is billed to the insurance company.
Depending on your in-home family size and the household income (including wages or salary from employment, child support, unemployment compensation, welfare grant, or other source of income for all adults living in the home), your out-of-pocket, adjusted fee may be less than the $85.00 fee. A Sliding Fee Scale is used to determine your fee to help make therapy affordable for you. You will never pay more out of your pocket than your adjusted fee for a session.
If you have insurance, the amount paid by the insurance company will apply to the $85.00 cost. After this, you will pay the difference between the insurance company's payment and the $85.00 fee. However, if this balance exceeds your adjusted fee, you will pay only your adjusted fee amount. If the difference between the insurance company payment and the $85.00 cost is less than your adjusted fee, you will pay the amount that is left unpaid after the insurance payment.
For example, if your insurance pays 50% of the $85.00 cost, $42.50 will be due from you. The Sliding Scale does not go lower than $45.00. If the insurance pays 80% of the $85.00 cost ($68.00), you would pay $17.00.
In another situation, if the insurance pays only 20% ($17.00), you would pay whatever your Sliding Scale Fee is. If your adjusted fee is $65.00, you would pay $65.00. If your adjusted fee is $45.00, you would pay $45.00. If your established fee does not warrant adjustment on the Sliding Fee Scale, and your fee has been established as $85.00, you would pay $68.00 in this scenario.
You are expected to pay your adjusted fee at each session until your insurance makes the first payment to Thalia. If money is owed to you because you will then have overpaid, it will be refunded promptly. After the receipt of the first insurance check, you may then pay only what the insurance will not cover, up to your adjusted fee. However, if your insurance coverage should change for any reason, you will still owe your full adjusted fee for any sessions not covered. If Thalia is on the provider board for a specific insurance, and has agreed to accept their rates of pay, you may only need to pay your co-pay as established by the insurance company. Currently, Thalia is on the provider boards of the following insurances, although other companies may also accept her services:
Aetna
Aetna EAP
PPOM (with Cofinity gate)
Magellan EAP
Magellan
Tri-Care (Military)
APS Healthcare
Physicians Health Care Plan/PHCS/MultiPlan
Blue Cross/Blue Shield Traditional
MESSA
State of Michigan Mental Health Case Management Program
It is ALWAYS the best policy for a client to telephone the Customer Service number on the back of the insurance card BEFORE the first session to see if Thalia is covered by your plan and what amount of coverage will be paid. Thalia is an LMSW and a DCSW but there is no supervision by a medical doctor, as a few insurances require. Some insurances require a pre-authorization for your treatment and will not pay if you have not arranged this FIRST.
The therapist will bill your insurance for you directly, if you give her the information to do so. Some insurances send the payment check to you instead of to Thalia. In these cases, you are expected to sign the check over to Thalia or to write your own check to cover this amount, in addition to your adjusted fee. Failure to do this is fraud and is an abuse of the Sliding Scale Fee system, which Thalia has established voluntarily to help you afford therapy.
It is essential to realize that the difference between the $85.00 cost and your adjusted fee must either be paid by insurance or absorbed as a loss by the therapist. Since her capacity to absorb losses and still stay in business is limited, making sure that she receives any amount that insurance will pay toward your therapy is important. | 
