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Rates & Insurance
In order to make the process of seeking our services as easy as possible, we have outlined our fees for each service and our insurance policies. We hope this answers your questions about rates, insurance and billing policies. If you have additional questions, please contact us at 904-432-3321 and select option "2."
Therapy intakes are 90-minute appointments and the cost for the initial intake appointment is $195. Ongoing individual and family therapy sessions are 50 to 55-minute appointments and cost $130 per appointment. Insurance is accepted for therapy sessions.
If you will require extended sessions for crisis or non-emergency reasons, $65 will be charged for each additional half hour (30 minutes). This portion may be covered by your insurance. Please speak with your child's provider for more details. Please let your child's provider know if you will consistently require lengthier sessions.
Assessments are billed at $130 per hour. The cost of assessments includes the time required for administration, scoring, data interpretation, report writing and providing feedback to the patient and family. Prior to the first appointment, your child's provider will speak with you about your assessment needs and the type of assessment that will be performed. Because assessments are lengthier services with higher costs, payment in full is not required at the initial appointment. If they choose to, families can pay for assessments in 3 payments. The initial payment is due at the first appointment, the second will be due on the day of testing and the final payment will be due at the feedback session.
In rare cases, a particular type of assessment is requested and, upon initiation of services, additional areas of concern become apparent. If further testing is warranted, your provider will give you recommendations about additional testing and the associated costs. Further testing will not occur without your express consent.
Nautilus Behavioral Health accepts insurance for outpatient therapy. At present, we are In-Network Providers for Tricare (Select and Prime) and Aetna. We are out-of-network providers for Blue Cross Blue Shield/Florida Blue, United and Cigna. As changes in our insurance participation occur, we will update this information.
Assessment services are often not reimbursed by insurance, as evaluating for thinking and learning issues may not be considered "medically necessary." As such, in-network status does not guarantee coverage of assessment costs nor does it guarantee authorization for the number of hours required to complete the assessment. We will file claims for assessment services, however, we require self-payment for assessment unless a family has determined that their insurance plan will cover the cost of the requested assessment and we have independently verified that information.
We recognize that understanding insurance benefits can be challenging and we will do what we can to make the billing process as simple as possible. We file claims on behalf of our in-network and out-of-network patients and/or can provide patients the documentation they need to follow-up with their insurance company if needed (i.e., Superbill for visit). If you are using insurance (in-network or out-of-network benefits), it is important that you contact your insurance company prior to your first appointment to discuss your coverage. Questions about your insurance benefits will best be answered by your insurance company. To fully understand your mental health coverage, please obtain the following information from your insurance company prior to your initial session:
Whether you need pre-authorization from your insurance company to receive mental health services
Whether you need a referral to receive mental health services and, if so, from whom
Any limits on services (e.g., number of sessions per year, individual versus family therapy)
Whether your insurance company follows a calendar or fiscal year (plus start and end date of the fiscal year, if applicable)
Your financial responsibility for services:
What your copay is for outpatient therapy delivered by a licensed psychologist
Whether you have a deductible that must be met before insurance will cover part of the cost of services, what that deductible is and the amount remaining until your deductible is met for the year
Whether you are responsible to pay coinsurance upon meeting your deductible and, if so, the percentage of the service costs for which you are responsible
What your insurance company considers to be “reasonable and customary” fees for 60-minute outpatient therapy sessions, which relates to your coinsurance cost and to how long it takes to reach your deductible
You are responsible for obtaining any referrals necessary or informing us of any pre-authorization requirements prior to the initial appointment. Nautilus Behavioral Health must have insurance information prior to the initial appointment to verify benefits. If your insurance is inactive or ineligible, you will be contacted, given this information and may choose to cancel your appointment or pay out-of-pocket. You are responsible for knowing the limits of your insurance. In the event of an insurance denial of payment, you are personally financially responsible for charges. If a deductible applies, you are responsible for paying for the hourly costs of treatment at the time of service until your deductible is met.
Should I use my insurance benefits?
Whether or not to use insurance benefits for mental health treatment is a very personal decision. Here are a few points to consider when deciding whether to use your health insurance benefits.
It is important for you to know that personal health information (PHI), such as your child's diagnosis, will be disclosed to your insurance company if you choose to use your insurance benefits. Insurance companies may also request other information to determine coverage and reimbursement.
Your child will have to receive a diagnosis in order for therapy services to be covered by insurance. Not everyone who participates in therapy has a mental health diagnosis. For instance, those who need help with general life skills or with a specific skill, like pill-swallowing, time management, or assertiveness, do not necessarily have a mental health diagnosis, but would need to receive one in order for services to be covered.
Some insurance companies may have restrictions about which providers you can see or limit the number of therapy sessions you are allowed each year. Once you have reached that number of sessions, you will either have to discontinue therapy or begin to pay out of pocket.
For families seeking assessment services, it is important to know that in order to bill insurance for an assessment, a child must receive a diagnosis at the onset of the assessment, which will be part of their medical record even if it is determined that the child does not meet criteria for that diagnosis. For example, if a family requests an assessment to evaluate a child for possible ADHD, the provider must diagnose the child with ADHD in order to bill insurance for the assessment, even if the assessment results suggest that the child does not have ADHD.
Regardless of whether or not you choose to use health insurance benefits, we at Nautilus Behavioral Health are here to help.
Conveniently located in Mandarin Serving Duval, St. Johns and the surrounding counties