Polluted Beach


We strive to hold the highest standards within our internal billing department at Cityscape Counseling. We do this by having a dedicated internal team solely for insurance and billing, submitting insurance claims daily, following up on denied claims and claims issues in a swift manner, using state of the art electronic software for claims management and accounting, and maintaining excellent relationships with our insurance partners. 

Below are detailed responses to Frequently Asked Questions involving how insurance works as well as our specific billing procedures.


How do we bill for your sessions with insurance?

If you are using insurance to pay for your sessions, an insurance claim is submitted the day after your therapy session to your insurance company. We use the insurance information you provide to us to submit these claims. If you do not provide us with updated insurance, then the claim will deny and the session cost will be your responsibility. We will always let you know when a claim denies and are more than happy to resubmit the claims for you if you can provide us with an updated and active insurance policy. 

What happens after your insurance claim is submitted?

Once insurance processes your claim - we receive an explanation of benefits/electronic remittance advice from your insurance company directing us what to charge you based on your specific plan. For most plans, there is a deductible that needs to be met before insurance starts to cover a portion of the cost of therapy sessions. At the beginning of the year, we see around 95% of our patients having their insurance claims process towards the deductible and leaving 100% responsibility to the patient for the insurance rate cost of the session. We do not decide on these rates, insurance dictates to us what we need to charge you (the in network contracted insurance rate). As the year moves on, some patients meet their deductible and then owe a copay or co-insurance and some patients never meet their deductible and have to pay the insurance session rate throughout the year - this is out of our control and depends on what other medical expenses you have. Many patients are under the impression that insurance should be covering 100% of the cost of their therapy sessions, or that they should only be paying a copay. This really is only the case for about 5% of our clients who have plans with extremely high premiums, but for most patients, a deductible has to be met first. There used to be a cost-sharing waiver due to Covid in 2020 and 2021 but all insurance companies ended that last year. 

When are you charged for your therapy session/s?

Our practice policy is that the amount owed for sessions is due as soon as insurance processes the claims. This is a courtesy we offer to our patients as many practices require payment up front before insurance even processes. 

Unfortunately, insurance companies process claims on an unpredictable schedule. Despite our efforts to submit each claim the day after a session, insurance will sometimes process 1 claim at a time on a weekly basis but often they will not process for a few weeks and then will process multiple claims at one time. We do not charge anything to our patients until we get the results of the processed claim from insurance. Claim processing time varies from 1 week to 3 months depending on your specific plan. We recognize that this is a huge range, but again, it is out of our control when insurance will decide to process your claim. Most claims process within 1-6 weeks but we certainly have some plans that take up to 3 months. 

Therefore, sometimes you will be charged for 1 session per week and other times you will be charged for multiple sessions at once, because that's how insurance chose to process the claims. However, if you are being charged for multiple sessions at once, remember that this likely means that there were various weeks where you were being charged nothing at all. Rest assured, we have a very stringent accounting system to keep track of what sessions you are being charged for.

In summary, your card on file can be charged at any time but it will always be based on when your claims are processed by insurance. Sometimes it might be 1 charge and other times it could be for multiple charges. 

What can you do if you feel that insurance is not processing your claims according to how you expected they would?

For example, maybe you thought you only had a copay but your insurance appears to be processing all claims towards your deductible

If you receive a charge for a session that you believe should be a copay and not a deductible, please call the client customer service number on the back of your insurance card and ask the representative to clarify why your claims are processing the way they are. If insurance tells you that the claims processed incorrectly, then please provide us with a reference number for your call and we can follow up with them about adjusting your claims. Again, this is rare. Most of the time, insurance processes correctly and we have documentation to show how the claim processed. If you log into your own insurance portal that you can set up with your insurance company, you can also usually see how the claims processed. Again, we do not have control over how insurance chooses to process your claim, and it is often not in a manner that aligns with your original insurance benefits quote because the claims department at the insurance company makes the final decision of the how the claim is processed. Those benefits checks are not guarantees of payment from insurance but rather a preliminary estimate. Your signed policy with us upon intake is that you are ultimately responsible for whichever portion of the session insurance doesn't cover.

How can I know which sessions I have been charged for?

If you are working with a therapist at Cityscape Counseling, they have access to a list of all your sessions for the year to date and are able to see which sessions you have been charged for and which are outstanding. Again, when you see multiple credit card charges at once, you do not have to worry that you have been double or triple charged, you can rest assured that in that case, insurance processed multiple claims at once. At your session with your therapist, if you want to know what sessions you have been charged for, they can pull up your profile and easily let you know. We bill for over 1000 wonderful patients and cannot respond in live time to every request for what sessions you have been charged for. If you want to know this information, your therapist can let you know at the time of your session (not outside of session). They are not obligated to respond to emails outside of session time about this. If you are no longer working with a therapist, then we can provide you with this information. 

Which card/s do we charge?

In terms of charging credit cards, our policy is to have a maximum of 2 cards on file for each patient - an active credit card (not a debit card), and a HSA/FSA card if applicable. Billing will always attempt to charge the HSA card first if it is on file. If you see that your regular credit card has been charged, then you can assume that your HSA card declined. If you want to update your credit card on file with us, you can call Shannon at 580 360 8531 and leave a secure voice message or you can provide it to your therapist in session or you can securely email: shannon@cityscapecounseling.com with new credit card details.

Superbills and Statements

If you need a statement for an HSA card or a superbill for out of network reimbursement please email a request for that when you need it but we do not provide these automatically.

Need more help?


If you still have questions and concerns that have not been addressed above then please feel free to email: billing@cityscapecounseling.com or call: 224-208-5644 and we'd be happy to further assist you.


We greatly appreciate the opportunity for our therapists to continue to serve you. 

Cityscape Counseling Billing Department