In-network with Moda for outpatient therapy.
In-network for Moda Health. Direct billing, copay or coinsurance at the session, no paperwork on your side. Moda is Oregon-based and a primary PEBB carrier, so most Oregon state employees with Moda coverage can use it with me.
Request a free 15-min consultation →Direct billing, no paperwork on your end.
In-network billing means I send the claim to your insurer directly. You pay your copay or coinsurance at the session, and the rest is handled between me and them.
Moda Health, formerly ODS, is one of the major Oregon-based commercial carriers and a primary PEBB medical carrier. The two PEBB Moda tiers are Moda Synergy (the coordinated-care plan, with a designated primary-care relationship and a narrower in-network expectation) and Moda Summit (the more traditional open-access plan, typically with a higher deductible). That makes Moda one of the most common carriers I see for Oregon state government employees on either tier. Outside of PEBB, Moda's commercial footprint is heavy in healthcare and public-sector employers. Their behavioral health network is administered in-house. I'm in-network for the standard Moda commercial plans and for both PEBB Moda tiers. I bill Moda directly after each session, your copay or coinsurance is what you owe, and the EOB shows up in your benefits portal once the claim clears.
If your specific Moda plan turns out to be out-of-network with me, you have two options: pay the self-pay fee directly ($250 per fifty-minute session), or pay the self-pay fee and submit a superbill to Moda for out-of-network reimbursement. Most out-of-network benefits cover a portion. Some cover most of it.
What you should actually expect.
What's specifically worth knowing about Moda coverage before the first session.
Moda Synergy (the coordinated tier) and Moda Summit (the open tier) on PEBB usually have outpatient mental health copays in the $20-40 range after deductible. Some PEBB plan years have included a separate behavioral health deductible structure that's worth checking; member services can pull your specific year's benefit. Commercial Moda plans vary by employer group but most cover outpatient mental health at parity with medical. Telehealth has been at full parity since 2020. Moda's prior authorization process is minimal for standard outpatient psychotherapy; I haven't had a Moda claim denied for couples or family sessions billed under standard psychotherapy codes.
For the full carrier list and the out-of-network superbill explanation, the insurance overview covers the broader practice context.
What to ask member services.
The cleanest verification before our first session is a five-minute call to Moda member services. Here's the script that gets useful answers.
Call the member services number on the back of your card and ask these three questions:
- Is provider Gerry McNamara, LMFT (NPI available on request) in-network for outpatient mental health on my plan?
- What's my copay or coinsurance per session for CPT code 90834 (individual psychotherapy)? And for CPT 90847 if we're doing couples or family sessions?
- Has my deductible been met for the year? If not, how much is left, and does my plan have a separate behavioral-health deductible?
If anything they tell you doesn't line up with what I'm saying on the consult, that's a useful signal: we sort it out before the first session rather than after a surprise EOB.
Questions I get asked about Moda.
I'm on Moda PEBB Synergy or Summit. Are you in-network?
Yes for both. I'm in-network for the Synergy (coordinated) tier and the Summit (open) tier. I bill Moda directly, you pay your copay or coinsurance at the session, and the EOB shows up in your member portal once the claim clears.I'm not state government but I have Moda through my employer. Are you in-network?
Most likely yes. The standard Moda commercial plans cover outpatient mental health at parity and I'm in-network for them. The healthcare and public-sector employer groups are where Moda shows up most outside of PEBB. Member services can verify your specific plan tier.I have Moda through OEBB (K-12 educator). Does that work?
Moda was the OEBB carrier for many years, but lost the OEBB contract to PacificSource around 2018, and OEBB's current medical options are PacificSource, Providence, and Kaiser. A lot of veteran educators still associate Moda with OEBB out of habit. If your card actually says OEBB and Moda today, that's worth a verification call to OEBB benefits to confirm what your plan actually is; if your card says PEBB and Moda, you're on the state-employee plan and I'm in-network.Does Moda cover couples therapy?
In my experience, yes, under standard outpatient psychotherapy codes with a clinical diagnosis for one partner. Moda has been consistent in paying these claims. If you want to verify against your specific plan, member services can confirm whether relational counseling has any plan-specific limits.
What I help with that Moda covers.
Anxiety therapy
Practical, multi-modal anxiety therapy. Covered by Moda the same way any standard outpatient mental health visit is.
Read moreDepression therapy
Depression therapy for adults who are tired of being tired and want to understand what's underneath.
Read moreCouples therapy
Gottman-trained couples therapy. Insurance coverage for couples depends on plan specifics, which we'd verify on the consult.
Read more
Ready to talk it through? Let's see if we're a fit.
Send a message, or set up a free 15-minute phone consult. You can reach me by email, call, or text. I'll get back to you within two business days.