Each insurance company and insurance plan is unique. A copy of the insurance card front and back is required to process claims. Breakthrough Counseling, LLC does not accept all insurance providers, but will do its best to work with the responsible party to determine an agreeable program cost. To know what the out of pocket costs for therapy will be after insurance, the client’s insurance customer service will need to be called. When speaking to a representative, inform them of the following:

1. Seeking mental health services at Breakthrough Counseling, LLC in Sioux Falls, South Dakota.
2. Calling to learn of the out of pocket costs for “psychotherapy” for the client.
3. If they require the name of a therapist, ask regarding Breakthrough Clinical Director Krysta Winter, LPC-MH, QMHP.
4. Let the representative know the following billing codes, and they should be able to state the out of pocket costs for each service.

Psychotherapy Billing Codes and Cost to Insurance

• 90791 Psychosocial Intake – $250
• 90853 Group Youth Therapy – $50
• 90847 Family Psychotherapy with client present – $225
• 90837 Individual Psychotherapy 60 minutes – $225
• 90849 Multi-Family (Parent) Group Therapy – $30
• 90846 Family Psychotherapy without client present – $150

At times a client may require more than one service per day, however most insurance providers will only cover one session per day. This means that any other documented sessions would not be covered, and therefore would need to be paid out of pocket. On average, an out of pocket 60 minute session is $150. To prevent you from having to pay out of pocket for non-covered services, they are documented as “Interventions” with a direct bill rate of $1/minute. This brings the cost of a 60 minute additional session from $150 to $60, saving you over 50%. Interventions will be documented and billed when any of the following criteria are met:

• Intervention lasts less than 25 minutes.
• Client has already had a session that day but requires an additional meeting.
• Client has not already had a session that day, but has one scheduled later that cannot be changed.
  • Examples of sessions unable to be rescheduled could include Client Group Therapy, Family Therapy, or a longer and more intentional Individual Session.

Recording how much time therapists spend on each case allows us to better track youth progress. This assures that they are receiving proper care and that we are moving forward in their treatment goals. To better categorize the additional charges you can anticipate, we have estimated (based on prior data) additional costs by client level of care. A client’s level of care is defined by the services they receive, both clinical and additional. Your child’s additional service costs may or may not reflect the below estimates. Levels are determined by client need and therapist time. Your therapist may incorporate specific services into their treatment plans, but levels are never pre-determined.

• Level 1 – Additional $5-$10/Month
  • Individual Therapy; Care Team Coordination, Therapist/Guardian Communication.
• Level 2 – Additional $10-$20/Month
  • Individual Therapy; Family Therapy, Care Team Coordination, Care Team Meetings, Therapist/Guardian Communication.
• Level 3 – Additional $20-$40/Month
  • Individual Therapy; Family Therapy, Group Therapy, Care Team Coordination, Care Team Meetings, Therapist/Guardian Communication, Part-Time Education Services, Miscellaneous Interventions, Parent Group (When Offered).
• Level 4 – Additional $40-$100/Month
  • Individual Therapy; Family Therapy, Group Therapy, Care Team Coordination, Care Team Meetings, Therapist/Guardian Communication, Full-Time Education Services, Miscellaneous Interventions, Parent Group (When Offered), Crisis Needs.

Breakthrough strives to provide the level of care that meets the needs of your child. In order to be available for timely correspondence, consultations, education interventions, and client crisis needs, Breakthrough therapist case loads are lower than the average outpatient practitioner. To maintain this level of care, Breakthrough direct bills for therapist time spent on client cases outside of session at a rate of $0.50 per minute or therapist sent email. Services that accrue additional charges include:

• Therapist/Guardian Emails and Phone Calls
• Care Team Coordination (Case Discussion with approved care team members such as school counselors)
• Care Team Meetings or Consultations

Communications regarding paperwork, insurance, billing, or scheduling should be directed to Office Manager Alexis Giff at no additional charge.

Medicaid clients must have a Primary Care Phyisican referral for services. Contact the client’s provider and have them fax the referral to 605-275-2026 – Attention Alexis Giff. Therapists under certain licensure supervision are unable to provide services to Medicaid clients.

Any changes to names, address, or insurance need to be reported promptly to Breakthrough Office Manager Alexis Giff at agiff@breakthroughsfc.org to ensure billing processes smoothly. A copy of the insurance card front and back is required to process claims.

Please discuss the need and request information on financial assistance options and payment plans prior to scheduling the first session to ensure that all necessary forms and applications are completed prior to billing.

No shows and/or cancellations within 24 business hours will result in a non-refundable missed appointment fee of $125. Three missed appointments that accrue a fee may result in losing a regularly scheduled appointment time or termination of services. Fees are not charged if cancellation occurs due to inclement weather or illness. If sessions are affected by weather conditions, clients may be offered a Telehealth session. A fee will not be charged if a client declines the Telehealth option. Scheduling conflicts such as school activities or other appointments should be communicated to the Breakthrough Office Manager at least 24 business hours in advance to avoid being charged a fee.

If Breakthrough has not received payment after an extended time, and a payment plan has not been put in place, services will be suspended until conversations are had regarding the situation. After 90 days a letter will be sent out requesting payment. After 2 notices Breakthrough will process to collections. Client may be discharged due to non-payment.