Tips for speaking with Your insurance
for possible reimbursement through out of network benefits
As you know, I do not accept insurance. I do, however, provide my patients with what's called a SuperBill that outlines the services rendered so you can submit to your insurance for partial reimbursement, if your plan allows.
I always suggest patients speak with their insurance if consistent therapy attendance is contingent on partial insurance reimbursement. This will give you an understanding of how much, what services, and how frequently your insurance company will reimburse you so you can make the decision that’s best for you.
1. Do I have out of network benefits for mental/behavioral healthcare? If yes- Please describe my out of network benefits package.
2. What percentage of the fees rendered are covered by my out of network benefits?
3. How frequently are reimbursements distributed?
4. How do I submit a request for reimbursement?
5. Do I need a pre authorization from my provider or a referral from my PCP in order to be approved for reimbursement?
6. Other than a Superbill, is there any documentation that you would need me to submit for reimbursement?
7. Do you have a time frame in which you no longer reimburse after from the time when services are rendered?
When speaking with your insurance it's important to ask:
CPT Codes
Insurance companies use “CPT codes” that correspond to services rendered. The session codes you’ll want to provide them that correspond to the work we would be doing together are:
90791- 75min Intake
90837- 60min sessions
90834- 45min sessions
90832- 30min sessions
90847- Family session with patient present
90846- Family session without patient present
It is important you have a clear understanding of the procedures of your insurance company, how to complete the necessary paperwork and the documentation required to include in your submission. If you have any questions on this, I encourage you to follow up with your insurance company to gain clarity.
Unfortunately, there is no uniformity between the processes of insurance companies and even between individual plans, thus being as informed as possible will always be the best route prior to initiating services.
Reminder
No Call/No Show or Late Cancellations without 48hr notice and/or Consultations and Secondary Work are not reimbursed by insurance companies thus the you are responsible for the full fee for the service rendered.