Visit us Mon-Fri from 9:00am to 7:30pm
 3825 Market St, Suite 4
REASONABLE AND APPROPRIATE
Medical Necessity

Health care services that are paid by insurance companies require reasonably justification based on evidence-based clinical standards of care before evaluation, diagnosis, or treatment of an illness, injury, disease, or its symptoms can take place.

Most insurance companies require a diagnosis that will remain on your permanent medical records and usually dictates how many, and what types of therapy you are eligible to receive. We believe that all your treatment options should be decided between you and your therapist.

FULL REIMBURSEMENT
Out of Network
Out of network image

Our services are reimbursable by most "out of network" insurance plans. Meaning that your insurance company will fully or partially reimburse for care that is outside their network of health care providers. Please contact your insurance company and request an authorization for out-of-network treatment prior to initiating contact with us. Questions about out-of-network benefits, or what percentage you will pay for out-of-network psychotherapy can typically answered by your insurance benefit plan manager.

We currently do not accept Medicaid or Medicare. We also do not participate with BCBS Blue Value Plan.

NORTH CAROLINA’S TRANSFORMATION
Medical Necessity

If you are eligible for managed care and receive benefits under North Carolina’s Medicaid program, you probable were asked to choose a health plan. Wilmington Mental Health participates in the following managed care plans:

AmeriHealth Caritas NC
BCBS Healthy Blue
WellCare of NC
Carolina Complete Health
UHC Community Plan
LIMITED NETWORK
Not Participating

We currently do not accept Medicaid or Medicare. We do not participate with some commercial insurances that are part of Medicaid. We also do not participate with BCBS Blue Value Plan (this network product has been closed since 2014).

Private Pay

Paying for care through self-pay as opposed to utilizing your insurance can be difficult, unless you are financially affluent. Out-of-pocket payments have some advantages, including how much control you and your therapist will have regarding treatment decisions, length of therapy sessions, and your confidentiality. That being said, when seeking mental health treatment please keep in mind the following:

  • We cannot guarantee that your insurance company will pay for services rendered or follow through with their original Explanation of Benefits (EOB).
  • We offer flexible payment options to make mental health care more accessible for the average self-paying patient.
  • Please remember that payment is due when services are rendered. We prefer to collect payments at the beginning of the appointment rather than at the end. If you cannot afford to pay the entire cost of your visit on the day of the appointment, you will be asked to complete a promissory note.
  • If you recently lost your job, you may qualify to continue health coverage under COBRA and keep your health insurance for a specified period of time, as long as you continue to pay the premiums.
  • Psychotherapy is typically covered by pre-tax Flexible Spending Accounts (FSAs) or Health Spending Accounts (HSAs).
  • Insurance companies will ask us to provide a diagnosis, in addition to information pertinent to your treatment, such as the treatment plan, current psychosocial stressors, and level of functioning.
  • Out of respect for your privacy, we will disclose only the minimum amount of information necessary to justify the services provided. WMH believes mental health treatment is a right, not a privilege. We will gladly help you determine the best treatment course, should the coverage with your health plan become an issue.
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AVERAGE AMERICAN
The Price of Health Care
When you seek treatment for mental or physical health, you are taking personal responsibility and lowering the risk of developing a disease. Investing in your health through out-of-pocket payments can, nevertheless, create a financial barrier and decrease the use of preventive services and uptake of preventive medications. Receiving treatment, on the other hand, may increase your chances of living a healthier and longer life.
Why investing in your health is important?
The global pandemic has made us more aware of the importance of investing in our health. Take for instance the impact counseling could have in your emotional and psychological health if you were facing an emotional burden, you cannot resolve alone. People who are unfamiliar with therapy may think about the financial investment and time involved in therapy, which in turn dissuades them from seeking out help. This brings us to the question, is your health, then, worthy?
Benefits of Psychotherapy
  1. Emotional relief and stability
  2. Recognition of distorted thinking and self-defeating behaviors
  3. Increased confidence, self-esteem, and communication skills
  4. Mental and emotional health education
  5. Better expression and management of emotions
  6. Improved problem-solving and conflict resolution abilities
  7. Greater sense of self and purpose
Benefits of Medical Care
  1. Continuity: Your PCP follows you through old age
  2. Convenience and access to a wide variety of health services
  3. Health maintenance and prevention
  4. Early detection through regular checkups
  5. Better communication with your treatment team to reduces stress
  6. Coordination of care across settings and providers
  7. Medication management
PRICE TRANSPARENCY
Standard Fees and Length of Sessions
Wilmington Mental Health is committed to providing useful price information for our patients. We want to help anyone trying to make a decision about receiving services be informed and better understand their health care costs and/or out-of-pocket responsibilities. The best way to understand your true out-of-pocket costs for health care services is to speak directly with your insurance company or to request an estimate from our team.
Below is a chargemaster for each outpatient services or item provided by WMH. The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid. It is possible that in situations where a patient does not have insurance, Wilmington Mental Health can apply discounts to the amounts charged.
Please keep in mind that the amount listed in the chargemaster below is not necessarily the amount a patient will pay for services. We typically receive lower reimbursements than the amounts posted on the chargemaster due to discounts negotiated with commercial insurance companies.
Behavioral Health Services
Psychiatric Services
Primary Care Services
Telehealth
Rate
Teletherapy
Health-related services and information distributed via electronic information and telecommunication technologies.
Psychotherapy Treatment
Free
Brief Telephone Consultation
15-minute consultation over the phone
$120
Individual Therapy Session
53-minute-long standard therapy session conducted face to face.
$150
EMDR Therapy Session
Brief individual therapy sessions typically delivered one or two times per week - on consecutive days if necessary.
$120
Biofeedback Therapy
30–60-minute sessions designed to develop awareness of your body functions using electronic instruments.
$150
Couples Therapy Session
60-minute session for individuals, partners, spouses, or engaged couples.
$200
Family Therapy Session
60-minute sessions for families of three or more who are part of the same household.
$100
Premarital Counseling
60-minute sessions designed for those in a committed relationship.
$40
Groups Therapy Session
60-minute-long sessions for groups of 12 people or less.
$15
Psychoeducational Class
60-minute-long educational sessions that promote sharing and personal growth.
$200
Crisis Intervention
Immediate and short-term emergency response for acute crises, such as suicidality or domestic abuse.
Assessments
$200
Comprehensive Clinical Assessments (CCA)
60-minute-long screening and full intake evaluation, which often is completed during session one.
$200
Substance Abuse Evaluation (CCA + Report)
60-minute-long assessment diagnostic interview to determine your level of care and needs.
$1500
Clinical Psychological Evaluation
Clinical diagnostic interview followed by psychological testing, feedback, and a written report.
$1000
ADHD Testing
Clinical interview that incorporates IQ, cognitive, emotional and behavioral testing, feedback, and a written report.
$1500
Immigration Evaluation
Clinical assessments for persons who are navigating immigration proceedings.
$2500
Sex Offender Risk Assessment
An empirical method of measuring the risk of re-offending that includes a comprehensive report.
Employee Assistance Program
TBD
Employee Assistance Program
53-minute short-term, voluntary sessions for employees experiencing personal and/or work-related problems.
$90
Compassion Fatigue Treatment
45-minute short-term sessions for those experiencing physical and emotional exhaustion.
Miscellaneous
$500
Deposit
Required for scheduling an evaluation. If you cancel within 48 hours the $250.00 deposit will be returned.
Policies and Attendance
$50
No Show - No Call / Late Cancellation
A fee is applied after a missed appointment, or after the cancellation deadline.
$35
Returned Check Fee
A bounced check penalty from a bank can cost around $35 in the form of a nonsufficient funds fee. We do not participate in reimbursement from Workman’s Compensation. However, we will still treat you as a patient, but payment will be expected at the time of service and will be the patient’s responsibility.
We accept Cash, Checks, Visa, Mastercard, American Express, and Discover.
All payments are expected at the time of service. Should payments not be made on the day of service, we reserve the right to cancel your appointment.
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Reduced Rate
Rates are subject to change. We may be able to lower the cost of your treatment if your income is low, or you have less money to spare after your personal expenses. Before we can assess your eligibility, we may ask you to provide evidence of income/no income.
Psychiatric Care
$250
Full Psychiatric Evaluation
60-min-long process used to diagnose problems with memory, thought processes, and behaviors.
$125
Follow-Up Medication Management
Ongoing medical monitoring related to the use of the psychotropic medication.
$125
Monitoring and Follow Up
Through review of the possible side effects of psychotropics to create a treatment plan and monitor their safety and efficacy.
Free
Referral
Ethical and efficient transfer of care process.
Miscellaneous Charges
$25
Family and Medical Leave Act
Medical certification issued by the health care provider because of a need for leave due to a serious health condition.
$50
Short-Term and Long-Term Disability
Paperwork to support application for benefits from the disability income plan of North Carolina.
$25-$75
Other Paperwork
An empirical method of measuring the risk of re-offending and includes a comprehensive report.
$100
No Show - No Call / Late Cancellation
A fee is applied after a missed appointment, or after the cancellation deadline.
Family Medicine
$150
New Patient Visit
Through review of past medical history that may include blood work or other testing.
$125
Preventative Care & Screening - New Patient
120-min long screening and full intake evaluation, which often is completed during session one.
$100
Follow-up Visit
Medical checkup to review progress since last appointment and identify, to make further assessments and/or adjust treatments.
$125
Annual Wellness Exam - Adult
Preventative visit for screening and wellness maintenance.
$150
Senior Wellness Exam
Basic check-up and review of personal and family medical history.
$75
Health Screening
Blood pressure, cholesterol, tuberculosis.
$20-75
Vaccinations
Immunization schedules for adolescents, adults, and seniors
Varies
Diagnosis Procedures
Gynecological procedures, abscess treatment, active management of chronic diseases, PAP smear
$300
Sexually Transmitted Diseases
Screening, testing and treatment of common bacterial STIs
$10-$50
Lab Tests
Allergy panel, pregnancy test, flu, strep, A1C, CBC, CMP, Free T4, Lipid panel, liver, PSA, TSH, vitamin D, NMR, blood typing, free T3
$299
Genetic Test
DNA medical testing that analyzes clinically important genetic variations in DNA
Free
Care Coordination
Management of patient care activities and referral process
Policies and Attendance
$25
Missed Appointments/No Shows
Fee applied after a missed appointment, or after the cancellation deadline.
Membership
$50
Registration Fee
Enrollment fee per person that includes medical services
$100
Individual Membership
Monthly fee is based on age. Includes cost of office visits, access to medical records, lab and test results, in-office lab testing, office procedures, online access to PCP, coordination of care, access to discounted medications.
$300
Family Membership
Monthly fee is based on family size: Up to 5 family members. Additional children and out of town students are $25/month. There are no charges for other services including office visits, standard labs, and most procedures.
Balances
$200
Outstanding balance shall not exceed $200.00. Services not paid by insurance company within 120 days will be classified as a self-pay.
$198
This is your deductible per calendar year required by Medicare. After the deductible is satisfied, Medicare will pay 80% of allowed charges. You will be responsible for the remaining 20% if you do not have secondary coverage as a supplement.
Rates are subject to change
EXPECTED CHARGES
Billing Protections
Good Faith Estimate
We have a responsibility to outline the estimated cost of the total expected cost of any nonemergency service we offer, including related costs like refills, tests, and other company fees. You can ask us to provide you with this estimate before you choose to schedule an appointment.
No Surprise Bill
You are protected from balance billing when you receive services by an out-of-network. In this case, you will not be charged more than your plan’s copayments, coinsurance and/or deductible.
Billing Questions
If you have questions about your WMH bill, please call (910) 777-5575 Monday - Friday 9:00 a.m. to 7:30 p.m.