Do you offer counseling sessions online?

Currently, Dr. Ruan is offering telehealth services using a secure, HIPAA-compliant videoconferencing platform, Zoom. Instructions for video chat will be handled privately. When doing online therapy, it is highly recommended that you have a video camera, without which it is much harder for the therapist to make eye contact with you.

For couple/ relationship clients, the practice uses Zoom to offer sessions for up to three people, including Dr. Ruan simultaneously at the present time. This may require the participant to set up his/her account via Zoom, and again the practice can send out a meeting ID when scheduling a session, and the participants join by entering the meeting ID.

I’m from another state; do you see cross-state clients?

Dr Ruan is currently licensed in the state of Washington (Virtual and physical), Virtual-Only (Texas, Connecticut, Oregon).

Insurance, Superbill, Out-of-Network Reimbursement

V2020 Counseling is a private-pay, out-of-network practice. Payment is due at the time of service. As a courtesy, I can provide a superbill that you may submit directly to your insurance company to request possible out-of-network reimbursement.

What is a superbill?

A superbill is an itemized statement of services that contains information commonly required by insurance companies, such as the date and type of service, fee paid, provider information, and, when applicable, a clinical diagnosis.

Providing a superbill does not mean that your insurance company will reimburse you. Each insurance plan has different rules regarding out-of-network mental health benefits, deductibles, allowable amounts, and coverage for couples or family therapy. The decision regarding reimbursement is made solely by your insurance company.

Couples Therapy and Insurance

Insurance coverage for couples therapy varies considerably among insurance companies and individual plans.

• When the primary focus of treatment is the couple's relationship, a relationship-focused Z code (sometimes referred to as a V code) may be used to describe relationship distress rather than assigning a mental health disorder to one partner when such a diagnosis is not clinically appropriate. Some insurance plans reimburse services associated with relationship concerns, while others do not.

• If a mental health diagnosis is used, I will only provide a diagnosis that is clinically appropriate and supported by my professional assessment. I will not assign or change a diagnosis solely for the purpose of obtaining insurance reimbursement.

• Insurance plans also differ in the length and frequency of couples sessions they will reimburse. For example, some plans may reimburse only one unit or a standard-length session (such as approximately 50–60 minutes) per week, even when a longer couples session is clinically recommended. Other plans may reimburse extended sessions, including sessions lasting up to two hours. Coverage depends entirely on your specific insurance company and plan.

For this reason, I strongly encourage you to verify both couples therapy coverage and session-length limitations directly with your insurance company before assuming that a longer session will be reimbursed.

Your Privacy

Please be aware that submitting a superbill involves sharing certain clinical information with your insurance company. This typically includes a diagnosis or relationship-focused code and information about the type and dates of services you received. Once information is submitted to an insurance company, it becomes part of the insurance claim and may be reviewed according to the insurer's policies and applicable law.

If your insurance company requests additional clinical records or treatment information, I will discuss the request with you before releasing information when authorization is required. A request for records is different from providing a routine superbill and may involve additional private clinical information.

Your Responsibility for Verifying Benefits

Because I am not contracted with your insurance company, I cannot determine your benefits or guarantee reimbursement.

Before beginning therapy, I strongly encourage you to contact your insurance company and ask:

• Do I have out-of-network mental health benefits?

• Does my plan reimburse couples or family psychotherapy?

• Does my plan reimburse services billed with a relationship-focused Z code?

• Is a mental health diagnosis required for reimbursement?

• What is my out-of-network deductible, and how much of it has been met?

• What percentage of the allowed amount will the plan reimburse after the deductible?

• What session lengths will my plan reimburse—50/60 minutes, 90 minutes, or up to two hours?

• Is there a limit on how many units or how much therapy can be reimbursed per day or per week?

• Do I need preauthorization or a referral?

• How do I submit a superbill or out-of-network claim?

When speaking with your insurer, please remember that a statement such as "we cover 60%" does not necessarily mean reimbursement will equal 60% of my session fee. Insurance companies may calculate reimbursement based on their own allowed or usual-and-customary amount, which may be lower than my actual fee.

Payment and Reimbursement

You are responsible for payment of the full session fee regardless of whether your insurance company reimburses you.

If you choose to submit a superbill, the claim is submitted by you directly to your insurance company. Any reimbursement is generally paid directly to you. V2020 Counseling cannot guarantee whether a claim will be accepted, how much will be reimbursed, or how long reimbursement will take.

I am happy to provide accurate documentation of the services I have provided and to answer reasonable questions about the information appearing on your superbill. However, questions regarding your specific benefits, deductible, allowable amount, session-length limitations, claim status, or reimbursement should be directed to your insurance company. My goal is to be transparent about this process so that you can make an informed decision about using your insurance benefits while also understanding the privacy and clinical considerations involved.