Frequently Asked Questions

Just like the imaginative and adaptable nature of a sandbox, we understand that each individual’s journey towards mental wellness is unique, filled with questions and curiosities. Here, you’ll find answers to common questions about our services, approach, and how we tailor our therapy to meet the diverse needs of our clients. Our goal is to provide you with clear, helpful information. If you have any questions that aren’t covered here, please don’t hesitate to reach out to us – we’re here to help guide you on your journey!



Where did the name “Sandbox Therapy Group” come from?

There’s a long history to Sandbox, going back to around 2012 or so. When the company originally formed, video games fueled its inception. Specifically, the genre of sandbox games! In a sandbox game the player is offered various tools that they then have the freedom to explore and craft their gameplay. Meaning, their journey unfolds in a non-linear way, without predetermined instructions or predefined objectives. The player invents their purpose by having unrestricted access to their entire gaming world (the box) with the ability to change their world at will (the sand and accompanying bucket & shovel). This approach to a highly tailored, self-driven environment is how Sandbox Therapy Group spawned! We are a company whose lens aspires to place fun at the forefront of care, and while form (techniques to learn new skills and receive personalized support) and functionality (root of areas of needs) has its place in due time, our team see ourselves as the experts in mental health care and you as the guide in how your care should unfold – playfully, practically, and pragmatically speaking! Together, Sandbox Therapy Group hopes to create a therapeutic narrative that honors your preferences to play, create, learn, and be taught what you are seeking in your mental health care! What this means in its simplest form is – ultimately, there is no “game” method, structure, or linear plot we impose on you without your approval and input!

But wait a minute! How do you do this with teens or adults, because they don’t play video games or with toys, right?

Great question! It always makes our heart sad to hear phrases like “I’m too old to play!” If you ask us, somewhere along the way you may have learned, thought, or been told this, and here at Sandbox we simply do not agree! Toys are symbolic, and play brings ideas and language to life. Play can be in the form of video games, toys, and any other recreational activities you experience enjoyment within. So, to answer this question, our therapeutic approach is for all ages and we firmly stand behind believing that playing is, too.

Can you describe your approaches and overall flow to care?

Our clinical work is rooted in therapeutic assessment (across the lifespan):

Our goal is to synergistically combine our expertises of assessment and treatment with your expertise of who you are and what brought you to us. Together, we shape your care into something we can both agree on. We do this by creating an open-ended, two-way street atmosphere where you feel comfortable being you, expressing yourself, and leave with a deeper understanding of how to be the best you you can (and want to) be! Some more details of how this commonly unfolds is below.

Process for this:

Step 1: Symbols: Work alongside patients to gain a cursory view of their worldview and culture(s), how they are operating in the environments they are within, and gather patterns to decipher how their behaviors might be functioning in their life. Some ways we do this include:

    • Screening for crisis/higher level of care (biopsychosocial factors).

    • Balancing observing and inquiring.

    • Mapping of goals, expectations, psychoeducation, and possible pathways forward.

    • Litmus test for motivation, abilities, and willingness to change.

    • Assessment of the personalized questions you seek to answer. 

    • Formulate functions of behaviors.

    • Discuss what change may look like in the future to honor your goals.

Step 2Systems: Gain an in-depth, expansive understanding of how behaviors play a role within the various parts of their life – work, school, hobbies, leisure, and social (family, friends) life.

Step 3Synergy: Collaboratively create their treatment plan with a deeper understanding of the interplay between their patterns, play, and performance.

    • While many view mental health care (therapy and/or assessment) as a way to identify a diagnosis a professional assigns, we view it as an engaging, enlightening, and empowering process. Sure, a diagnosis may ultimately be met, and if this is true our hope is you will have words to understand who you are, how your brain (and body) sees and interacts with the world, and what you could potentially do about it based on respecting your voice, viewpoint, and vision.

Do you have a waitlist?

Nope – at this time we do not have one!

I was previously diagnosed and told that there is no way I am autistic because I make eye contact and “hold down a job…there’s no way you are on the spectrum”. I think I mask really well, can you really help me?

Unfortunately, this is an incredibly common reported statement patients say to us when they seek our services. When working with these populations, especially when a person expresses hesitancies and fears due to prior ableism or inexperienced professionals, a lot of how we approach our care is by doing our best to set a solid foundation at the outset. We do this by being curious and asking questions in as sensitive of a way as possible, we aim to understand a person’s identity – we recognize this is not necessarily permanent and thus appreciate its fluid nature, ask if we can discuss any prior trauma and misunderstandings that has occurred to do our best to avoid this, explore what the patient’s lived experiences are, what is important in their care, ensuring we are checking-in if anything is changing or needing to shift gears (like to slow down or speed up) along the way, create a space the patient is able to be as honest as possible, and pausing periodically to reflect back in efforts to gain clarity if we are on the same page. Overall it is a fair amount of doing our best to ask the questions to avoid assuming, move at the pace that is best suited for their needs to capture what we need to move towards the best and most appropriate care they are seeking. We aim to take our time, dig-deep to find the roots and functions, be efficient and effective, include the patient in decisions, keep their voice at the forefront since they are the expert in who they are, and focus on the patient’s agenda while embedding suggestions we have along the way to see what might stick or need to be recalibrated.

What does neurodiversity-affirming mean to Sandbox?

Some of our staff (like Dr. Anna) are neurodiverse. With this in mind, we do our best to be careful in how that is applied in our care. Being affirming as a provider in this population means we view ourselves as an expert in evaluation/treatment of neurodiversity and see the patient as the expert in their lived experiences, and together we collaboratively create curated care plans and evaluations based on what Sandbox sees and the patient does (and needs)! It’s a back and forth, and while we recognize people come to us for various reasons, most times because they are in need of guidance and support; we also work to balance care with patients by bolstering their resiliencies and areas they naturally excel in, too. We view behavioral, social, emotional, cognitive and other functional skills that are reported as creating barriers in their life as opportunities to better understand the specifics of how they are causing limitations and then determine to what extent, if anything at all, they are seeking to change and thrive in their life. We are not a clinic that “forces” change or encourages “being normal”. Instead, our approach is to figure out what someone is coming to us for, see if we are a good fit, and then work together to collaboratively create a plan that meets their needs while bearing in mind any specifics that are important to them, such as cultural factors, communication preferences/styles, or lived experiences, etc.

Why aren’t you in-network with my insurance carrier like other therapists?

Three simple words can answer that: Investment. Intentionality. Integrity. Let’s explain this a bit more though. Allocating your resources upfront to more specialized and tailored providers can yield quicker and more cost-effective results both in the short- and long-term. An example of this is below; option 1 is actually fairly common in many patients that come to Sandbox Therapy Group:

Option 1: You decide you need to use insurance and meet with Dr. Insurance-Carrier (in-network with your insurance). They say they are generally familiar with autism, having read a book about it in graduate school so insurance has listed them as “qualified” to treat you, and so you meet with them for 3 years with little to no progress. You spent on average $35/session, as well as other coinsurance and deductible costs at every new year, for a total of $6,800.

Option 2: You pay out of pocket and submit to your insurance as an out-of-network provider to meet with Dr. Private-Pay. She is an expert in autism, having invested over 20 years in the field, and you meet with her for 2 months finding you go home with more targeted goals, experience an improved understanding of your needs, and a path forward that has now stabilized your mental health and addressed other areas of your life you did not realize needed additional support. You spent $90/visit for a total of $720 (your insurance reimbursed you for Dr. Private-Pay’s work as an out-of-network provider at $210/session).

Take home point here is that while you need to decide what is best for you and we respect what that choice needs to be, we also view private pay care as a strategic investment in one’s mental health for efficient, effective, and empowering outcomes.

The next area is intentionality. As out-of-network providers, our attention is undivided and we are able to set clear goals that honor patient needs and privacy (if they do not submit to insurance). We are able to approach their care by using specialized interventions that align with their desires, with a commitment to providing efficient and effective care that is mutually agreed upon.

This then folds into integrity, which involves Sandbox Therapy Group being honest and transparent with you about the rationale behind treatment and expected outcomes; when we are out-of-network with insurance, we can do our due diligence to ensure that the services provided align with your best interests, where you are kept informed of what options are available to you.

Overall, Sandbox Therapy Group has decided to remain out-of-network with all insurance after September of 2024 so we can focus our efforts in producing a nurturing, therapeutic environment that fosters confidence, clarity, and cohesion in your mental health care!

Why should we care if we submit your mental health services to insurance (be it in- or out-of-network)

It is incredibly important for you to consider how the potential establishment and application of a diagnosis and/or use of the term “disability” in any officially documented capacity can have long-term, irreversible impacts on your future that are outside of our control. By submitting to insurance that means you must have a diagnosis, which generally means you more-than-likely qualify for a disability. For example, things to consider include:

  • how the data can be used by anyone you provide the information to,
  • possible stigma,
  • extreme-distress as well as embarrassment from individuals that do not understand your diagnosis and/or disabilities,
  • insurance (such as life insurance) where pre-existing conditions can cause a denial of coverage,
  • disqualifications from certain government agencies or vocations, and
  • other potentially severe, restrictive, and unknown impacts to your ability to obtain or pursue things you may want due that can be specific to your circumstances that are impossible to predict.

We are happy to discuss this further with you as we want to ensure we provide information as best as we can so you can make the decision that is best for your needs.

Can you help us bill our insurance as an out-of-network provider?

Kind of…to a point. We can only provide you detailed invoices (AKA – superbills) for you to submit with your insurance company to determine any out-of-network reimbursements that may be available to you. This is available to you in our IntakeQ portal. We will *not* bill out-of-network on your behalf. Additionally, we will not agree to single case agreements. Many of our patients use Reimbursify – however, to be clear, we do not necessarily recommend or endorse this, we only mention this as a possible resource. Ultimately, speaking with your insurance carrier can help offer you options to streamline out-of-network reimbursement, where relevant.

What do we ask when we speak to our insurance about billing out-of-network?

This is a loaded question, so get ready for a mouthful! Every insurance carrier (e.g., Regence, Premera, Kaiser Permanente, Aetna, Cigna, United, etc.) has different policies based on the individual plan (e.g., your employer’s state-specific plan name, federally versus state funded, etc.) of what will and will not be covered under your out-of-network care. We cannot guarantee your insurance will cover the costs of our care, and you should be aware we have seen a lot of patients being verbally told by their insurance they will be covered for out-of-network costs, and then after a few months, we learn we are not covered. 

Again, we can never guarantee your insurance benefits or coverage, we are not responsible if your insurance cannot/will cover your medical costs for our provider’s rendered care now or decide after they pay you it was not a covered service (thus requiring you to pay it back). The following is meant to be informative and help support you in seeking the potential of out-of-network care. Bear in mind, insurance generally tells members: any quote given is not a guarantee of benefits or coverage; payment will be determined at the time of processing and is subject to change. Which essentially means, your insurance reserves the right to tell you it is covered, reimburse you, and then within a certain amount of time request it back (meaning, it was not deemed a covered service, for whatever reason they provide). 

With this said, some of the following may be helpful for you in speaking with your insurance relating to potential out-of-network coverage. Again, we cannot guarantee (nor promise) you will be reimbursed (even if your insurance says they will), and we cannot guarantee your insurance will not mandate it be paid back after they reimburse you (recoupment): 

  1. You can request for what’s usually called an “out of network waiver“. This would allow you to be treated by us as if we were in-network.
  2. When insurance says they will cover services rendered via telehealth (especially across state lines if you are working with Dr. Anna), ask your insurance carrier to write this prior-approval on their letterhead because it may help for future reference that you did your homework beforehand. An example of what information to have written in this letter, and to thus ask your insurance about for out-of-network coverage, could be something like:
    2. NPI: we will give you this number, it is a national provider ID number
    3. Diagnosis: we will give you this, this is your diagnosis code
    4. CPT Codes: we will give you this based on the service you are seeking
    5. Location: Telehealth – PROVIDER NAME located in Washington State, patient located CITY, STATE
    6. Ask how many units are allowed for each CPT code (we will help you)
    7. Ask what the “allowed amount” is per code, per day, per unit (again, we will walk you through this)
    8. Ask If there is prior authorization required

What is the difference between assessment and evaluation?

At Sandbox Therapy Group, assessment and evaluation are two processes used to gather information and make judgments about different aspects of a situation, performance, or person. Here’s a simple way to explain the difference between the two:

  1. Assessment: Think of assessment as the gathering of information. It’s like taking a snapshot or a measurement of something at a particular point in time. Assessment focuses on gathering data, observing, and collecting information about a person, thing, or situation. It often involves tests, observations, or other methods to gather data. For example, in education, teachers assess students’ understanding by giving quizzes or tests.
  2. Evaluation: Evaluation, on the other hand, is almost like an additive step… it involves making judgments or interpretations based on the information gathered through assessment. It’s like looking at the snapshot taken during assessment and determining its quality, effectiveness, or value. Evaluation involves analyzing data, making comparisons, and drawing conclusions. For instance, in education, after assessing students’ performance through tests, teachers evaluate their progress to determine if they’ve achieved the learning objectives.

In summary:

– assessment is about gathering information.

– evaluation is about making judgments based on that information.

Here is a visual that may be helpful to compare and contrast!


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