Rate & Insurance FAQs

Rate (Usual & Customary Fee)

$120.00 per 50 minute session (sliding scale available)

In-Network Health Plans (Plans with which I am contracted):

  • Anthem Blue Cross
  • Beacon Health Options (formerly ValueOptions)
  • Blue Shield of California
  • CA Health & Wellness/Cenpatico
  • Compsych
  • Espyr (EAP)
  • Lifeworks (EAP)
  • Cigna
  • Humana
  • Magellan
  • MHN/HealthNet (in-network only with Medi-Cal)
  • Military OneSource
  • Molina Healthcare
  • Optum/United Healthcare
  • Tricare/TriWest

If you do not find your plan in this list, it means your claim would be processed as out-of-network. You may be able to receive partial or full reimbursement for out-of-network services through your health plan. It depends on what your plan offers. We can discuss this when we meet at your first session.

Payment

I accept cash, checks, and all major credit cards as forms of payment. I also accept payment via PayPal.

Cancellation Policy

If you are unable to attend a session, please make sure you cancel at least 24 hours beforehand.  No-shows are deeply disappointing and unprofessional.

Health Insurance FAQs

Is psychotherapy covered by health insurance?

Most health insurance plans cover at least some forms of mental health care.  The Affordable Care Act (ACA) identifies mental health and substance use disorder services as essential health benefits, which include:

  • Behavioral health treatment, including counseling and psychotherapy
  • Mental and behavioral health inpatient services
  • Substance use disorder (or substance abuse) treatment

A few other things the law requires of marketplace health policies:

  • They can’t deny you coverage or charge you more just because your mental health issue existed before you bought a plan
  • They can’t place yearly or lifetime dollar limits on this type of coverage

So if you have health insurance, either through Covered California or your employer, it is likely that outpatient psychotherapy services will be covered.  Your eligibility and benefits for your plan will need to be verified when you enroll as a client.  Bring your health plan membership ID with you to your first appointment.

What is Medi-Cal?  Does Ryan Buchmann MFT accept Medi-Cal as health insurance?

Medi-Cal is the state of California’s version of Medicaid, a federal health insurance program that provides free or low-cost coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medi-Cal does in fact cover outpatient psychotherapy services. I can accept Medi-Cal through Molina Healthcare, HealthNet/MHN, or the Blue Shield of CA Promise Plan.  This means you must be a member of one of these plans in order for me to bill them for your services.  If you are insured directly through Medi-Cal, call the San Diego County access line toll free at 888-724-7240 to obtain a list of providers in your area who are open to accepting your coverage.

Does Ryan Buchmann MFT accept Medicare?

I cannot accept Medicare.  At this time, the federal Medicare program does not recognize a Marriage & Family Therapist (MFT) as a mental health provider.  Currently the only mental health clinicians that Medicare does recognize are psychiatrists, psychologists, and licensed clinical social workers.  Our hope within the profession is that this will one day soon change.

Why is it so hard to find a therapist who takes health insurance?

Most psychotherapists have decided to drop out of health insurance panels because reimbursement rates from the plans are too low.  Further, for some clinicians, the complexity of dealing with the necessary forms to in order to get paid for services makes working with health plans as a part of their business untenable. Therapists want to focus their energy and attention on helping people, not churning out paperwork in order to collect a payment.

Why does Ryan Buchmann MFT work with health insurance?

I have seen that people feel they are getting a genuine sense of value for their health care investment if they are able to receive quality mental health services from someone they feel they can trust. I have worked hard with health plans to develop an efficient way to process claims and receive payments so working with clients who want to use their insurance to pay for mental health benefits is possible.

When you send a claim to a health plan, what information is included?

To bill your health plan, I am required to submit the following personal, protected health information to your plan with each claim (this applies to any medical or mental health professional):

  • Your name
  • The address listed with your health plan (often your home address)
  • Your phone number
  • Your date of birth
  • Your health plan member ID number
  • A diagnosis that justifies the need for psychotherapy services (called “medically necessary”)
  • The date we met for therapy (called the date of service)

Occasionally, the health plan may conduct a clinical review of your case to verify that ongoing funding of your therapy is justified. If this happens (it’s pretty rare), the health plan clinician conducting the review will expect answers to the following questions:

  1. What is the diagnosis?
  2. How did I arrive at the diagnosis?
  3. What is the plan to treat the diagnosis?
  4. How much time will be necessary to complete the treatment plan?

I provide this information from your case history over a phone call (never via fax or email). The health plan clinicians (who are also licensed) are bound by the laws and ethics for confidentiality, so all of this information will remain protected and private. If the health plan representative/clinician approves funding of on-going treatment, it is often for 3-6 months of services.

Could a diagnosis included on a claim form come back to bite me later?

Only if you are a terrorist!  Otherwise, any information sent to the health plan is strictly confidential.  Disclosing a client’s protected health information would violate federal HIPAA protection laws and open the health plan to a world of scrutiny!  Health plans have extensive security procedures and protocols in place to ensure medical and mental health information is kept secure and private.  The information would never leak from the health plan to an employer or the military.

What is an EAP (Employee Assistance Program)?  Do you work with those?

I do in fact work with EAPs!  An employee assistance program (EAP) is a work-based intervention program designed to assist employees in resolving personal problems that may be adversely affecting the employee’s performance. EAPs traditionally have assisted workers with issues like alcohol or substance abuse; however, most now cover a broad range of issues such as child or elder care, relationship challenges, financial or legal problems, wellness matters and traumatic events like workplace violence. Programs are delivered at no cost to employees by stand-alone EAP vendors or providers who are part of comprehensive health insurance plans. Communication with an EAP is strictly controlled.  An employer can communicate only with the EAP, never directly with the clinician.  Further, the clinician can only communicate with the EAP, never directly with the employer.  So if an employee is in crisis (e.g. suicidal, under the influence of a substance, etc), the EAP is contacted for a course of action, never the employer. 

Any Other Questions

Please contact me for any additional questions you may have. I look forward to hearing from you!

Contact Me



330 Rancheros Dr Suite 222
San Marcos, CA 92069

rdbuchmann@gmail.com
(760) 566-8760

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