Payment and Insurance: Payment is due at the time of the session in the form of either cash, check, or credit card (Visa, MasterCard, Discover, and American Express). As a healthcare provider, I am also able to accept cards linked to health savings accounts. I'll provide you with an invoice at the session. If you wish, you can submit the bill to your insurance provider to seek reimbursement. You should consult with your insurance company about the need for pre-approval, the nature and extent of benefits for mental health treatment, and whether out-of-network provider services are reimbursable. See below for specific questions to ask your insurance company to help facilitate this process. Please note that I do not process insurance paperwork.
Although the choice to use your insurance for reimbursement of therapy is yours, please consider the following before making this decision:
• Insurance companies are designed to reimburse for the treatment of illness. Therefore, a psychiatric diagnosis is usually required before any reimbursement is allowed. Before the Affordable Care Act, a diagnosis was sometimes considered a preexisting condition if you needed to change insurance companies and some individuals were refused coverage as a result. This is no longer the case due to provisions of ACA, since coverage is provided regardless of any previous diagnoses.
• Some companies attempt to control many facets of your therapy. They decide whether treatment is medically necessary and whether your circumstances warrant treatment that they will cover. They also decide the type of therapy they will cover, and the duration and pace of therapy, rather than your treating psychologist.
• All insurance companies require some personal information in order to facilitate processing your claim. The extent of the information varies by the company. Some may simply require dates of service and diagnoses, others may require more information. I release this information only with your written consent. I think it important that you know what information is provided to your insurance company before you seek reimbursement.
I value confidentiality and believe that your therapy should be guided by you and not your insurance company. Therefore, I do not participate in any managed care plans nor am I an in-network provider for any insurance company.
In checking with your insurance company, there are several important questions to ask:
1) Am I covered if I see someone for psychological services who is not in your network? If your insurance company absolutely does NOT reimburse for out-of-network providers, you will not get reimbursed. Some insurance companies will make exception in unique circumstances, usually if they cannot provide in-network a service you need. For example, you might need a bilingual therapist and there may be no one in their network who speaks your language.
2) What is my deductible? The deductible is how much you have to pay out of pocket before reimbursement can be made to you. Make sure to check whether a deductible for mental health services is combined with your regular ‘major medical’ deductible, or whether it is separate. Some companies have a separate deductible for mental health services.
3) How many therapy sessions are covered in a calendar year? (This number ‘resets’ and may change each year on January 1). It helps to ask about this using the specific procedure code. The code for MOST individual patients is CPT 90834 (Individual psychotherapy). Couples and family therapy use CPT 90847. There are additional codes for sessions involving unique circumstances (e.g., meeting with parents of a child without the child present; meeting alone with the spouse of a patient) that may or may not be counted in the number of sessions per year.
4) What is the reimbursement percentage and allowable fee? The reimbursement percentage is the percentage of a fee the insurance company will cover. The allowable fee is the maximum fee they will cover. As an example, let’s assume your therapist charges $150. Your company covers 80%, but only allows a maximum $100 fee. You’d get reimbursed 80% of the $100, not 80% of the $150. Most therapist fees are higher than what insurance companies’ allowable fees are.
5) Do I need a diagnostic code and how do I file a claim? Almost all companies required a diagnosis in order to reimburse you. Some companies require paper filing and others have now switched to online filing of claims. Make sure you understand how this is done so that you can file claims and get reimbursed promptly. Keep in mind that there may be a time frame by which you need to file your claim, especially once the calendar year is over (e.g., claims for 2015 may need to be filed by a certain date in 2016 in order to be reimbursed).
Please feel free to contact me to discuss any questions or concerns you may have about insurance and fees.