Insurance

insruance

I do not take insurance but am considered an out-of-network provider. I do have the ability to superbill for my full fee which entails me sending you a receipt of the services you have been provided and you turning them into your insurance for reimbursement. Each insurance plan/company is different. Some may choose to give a full reimbursement while others may choose partial or not at all. It’s important to follow up with your insurance provider about this process.  

 

The following are questions to ask your insurance provider.

Be sure to write down what they say so you have a reference and to hold your insurance company accountable if they don’t follow through with what they say.

  1. Ask for the representative’s name and extension number.

  2. Does my policy reimburse out-of-network Licensed Professional Counselors (LPC)?

  3. My therapist is will provide a statement of Session Dates Attended, the CPT code, and the ICD-10 code. Is there any additional information needed?

  4. Does my policy cover Telehealth with a Licensed Professional Counselor (LPC)?

  5. Does my policy cover Individual Psychotherapy - CPT code 90834 (a 45-minute session) for me? CPT Code - 90847 couples counseling?

  6. How many sessions are covered per year? Is there a lifetime maximum for mental health benefits?

  7. What is my Out of Network deductible? (This is the amount you have to pay before they start reimbursing you.)

  8. What is the Allowed Amount of Fee? What percentage of the allowed amount will be reimbursed?

    a)   Note: reimbursement rates are dependent on your policy/insurance.

    b)   Note: If the insurance company chooses to withhold some of this information from you (they legally can) ask to speak with a supervisor and say you cannot plan for your medical expense budget without these numbers.

  9. How do I file a claim - online, or through the mail? What is the process?

  10. Is there a certain number of days from the date of service for my claim to be submitted to be considered for reimbursement? If so, what is that time period?

  11. What is the payment schedule? (This is the process of how long does it take for them to process your paperwork and then obtain your reimbursement)

  12. What is the phone number to the claims department, so I can follow up on the status of my claim at a later date?