Choosing to go out of network can be expensive. You should always first contact your insurance carrier to see if there is a provider in-network in your area that can address you or your child’s therapeutic needs.
On the back of your insurance card, locate the member services phone number. Call and ask for a list of in-network clinicians who are certified to treat Selective Mutism or the specific anxiety disorder for which you are looking to receive support.
You should be provided with a list of clinicians in your area that are in-network. When you call clinicians from this list, ask questions such as: Are they taking new patients? What treatment approach do they use? Do they specifically use evidence-based treatments, and if so, which ones? How much experience do they have treating Selective Mutism?
If there is no provider within a reasonable mile radius within your insurance network that specializes in or is certified to treat selective mutism, ask about an in-network exception.
An in-network exception (also called “single case agreement” or “gap exception” though could have other names depending on your insurance) is when your insurance will cover services by an out-of-network provider as if they were in-network. This means your reimbursement rate would fall under what is listed in the in-network column of your health benefits information.
When is it cost effective to go out of network?
IIt may be more cost effective in the long run to see a specialist for your specific therapeutic needs who can quickly and effectively treat the condition. Many clients at ECS will start with us, and then step down to in-network care for maintenance of their treatment gains. Our specialists are available to raise awareness of Selective Mutism and its treatment through consultations and training sessions with your in-network provider.
Treatment at ECS is meant to be short-term. If you see someone who is in-network but who does not specialize in treating the diagnosis, treatment may go on longer than it would with a specialist. This can create additional financial costs as well as greater social-emotional costs to you and your child.
It may be time to consider other options and look for a specialist who is out of network if (a) you have been working with an in-network provider and you are seeing limited progress, (b) any progress you have seen does not transfer to other settings (e.g., school or community), or (c) if you/your child’s symptoms are severe and the “usual and customary” in-network therapy is helping you/your child survive but not thrive.
What is a Flexible Spending Account (FSA) or a Health Savings Account (HSA)?
A Health Savings Account (HSA) or a Flexible Spending Account (FSA) allows you to pay for out-of-pocket health care costs with pre-tax dollars. When elected with your insurance policy, you typically receive a physical debit card that you can use to pay for health care services, and the amount is pulled from your health care savings account. ECS accepts payment from an FSA or HSA card.
ECS is a cash only practice. We do not work directly with insurance because the evidence-based treatment largely used at the practice—PCIT-SM—is considered a specialty service that does not fit within the “usual and customary” services that insurance plans cover as in-network services. However, this does not mean that insurance companies will not cover our treatment. Many policies have out of network benefits that will reimburse you for some or all of the cost of the session.
After a session with ECS, you will be charged the full fee for the session. You will then be provided with an insurance-reimbursable statement that you can submit to your insurance.
We understand that treatment at ECS is a significant investment. If you are interested in working with us, here are a few things to consider:
Services & Fees
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This is an information gathering session, where the clinician reviews information about the child’s developmental history, history of any previous therapy or support, the family’s psychiatric history, the presentation and maintenance of concerning symptoms, and the level of communication in all domains. The parents/caregivers share their treatment goals and what they expect to get out of working with ECS.
$250
CPT CODE: 90791
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Following the intake session, the clinician will work with the parents/caregivers reviewing the presenting diagnosis, diagnostic rule outs, symptom severity, and the recommended treatment plan. The clinician will provide psychoeducation about the diagnosis, how it is maintained, and the treatment interventions that will be used in session with their child. Any questions the parents/caregivers may have like: "What do I say to people when they ask my child a question and they freeze? Do I answer for them, force them to speak, or say, ‘They’re just shy’ and walk away?”, and “How can I make sure my child is included in the school curriculum and social events/opportunities before they are ready to use their voices?” are answered.
$150 / hour
CPT CODE: 90837
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PCIT-SM is a behavioral approach to treating anxiety and SM. It begins with the clinician and parent/caregiver building a trusting, warm and fun relationship with the child or adolescent. This phase of treatment is called CDI, or Child Directed Interaction. During CDI, the clinician puts no verbal demands on the child and allows them to lead the interaction. The clinician also works with the parent / caregiver during this phase, coaching them through the specific interventions learned in the Parent Training Session. These interventions are aimed at helping to reduce their child’s anxiety, and on increasing warmth in the relationship by becoming consistent and predictable during the therapeutic time. Once the trusting relationship has been established, and the parent / caregiver is comfortable using the interventions both in and out of session, the clinician moves to the next phase of treatment, called VDI, or Verbal Directed Interaction. During VDI, the clinician teaches the parent / caregiver specific intervention strategies to increase their child’s ability to use their voice with others following a specific stepwise protocol. Brave Talking exposures are planned and practiced in session, then implemented in real-life scenarios. Younger children benefit from a mostly behavioral approach to treatment (PCIT-SM alone). When working with older children and adolescents, the clinician also incorporates elements of Cognitive Behavioral Therapy, including interventions such as mindfulness, guided relaxation techniques, and challenging common thought distortions, among other CBT strategies.
$150 / hour
CPT Code: 90837
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By nature of the SM diagnosis, progress made in one domain (e.g., the office) does not always generalize to other domains (e.g., home, community). The clinician will therefore meet the parent/caregiver and child in each domain as needed to work on generalizing progress to those areas.
Community sessions typically occur in places like coffee shops, playgrounds, and ice cream stores. A communication goal is created and practiced in the office or at home first. The therapist then meets the family at the decided upon location to help support the child and parent/caregiver in following through and completing the goal using the specific PCIT-SM interventions.
Starting at $175/hour + Travel
CPT CODE: 90837
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School can be a difficult place for a child with SM to navigate on their own. It can also feel daunting to parents and caregivers when figuring out how to access school resources and accommodations as well as when and how to request an IEP or 504 meeting. This service creates a cooperative and connected team between you, the school, and the clinician, which can make all the difference for your child.
The clinician will with your child’s school via telehealth or in person, providing training to teachers, school counselors, and speech and language pathologists. Training includes education about the diagnosis and teaching specific interventions that can help alleviate your child’s anxiety in the school. This training also includes treatment planning with the teacher, counselor, and/or speech and language pathologist, where goals and expectations are designed for your child to work through at their own pace during the school year. The clinician can also help advocate for you and your child when requesting an IEP or 504 meeting with the school, and will attend the meeting to help educate the staff on the diagnosis as well as set appropriate IEP or 504 plan goals for supporting social engagement and verbal communication in the school.
Starting at $175/hour + Travel
CPT CODE: 90837