Payment and Insurance Reimbursement

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 and flexible spending accounts. This is all done securely through my patient portal.

I am NOT in network for any insurance company. I will provide you with a receipt/invoice for services via the portal, usually the day after a session. Superbills (Insurance Reimbursement Statements) that have all the information necessary to file claims with your insurance company are downloadable on the 3rd of the month following the provision of services.

If you wish, you can submit the superbill 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, this preexisting condition sometimes resulted in some individuals being refused coverage. This is no longer the case due to provisions of ACA, since insurance coverage is mandated 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, as noted above.

INSURANCE REIMBURSEMENT

In checking with your insurance company about out-of-network reimbursement, 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 any 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. Your deductible resets annually, so individuals beginning treatment late in the year may have to meet a deductible twice (end of first calendar year, and then again at the beginning of the new calendar year) before being reimbursed.

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). Family therapy uses 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 $200. Your company covers 80%, but only allows a maximum $100 fee. You’d get reimbursed 80% of the $100, not 80% of the $200. Most therapists charge fees that 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 2024 may need to be filed by a certain date in 2025 in order to be reimbursed).

Helpful Hints:

If you are filing paper insurance reimbursement forms, fill out one template form that has all the information that will stay the same (e.g., name, address, policy numbers, etc). You can then copy the form several times and fill out the claim-specific sections (e.g., dates of service).

You should also keep copies of all paperwork you submit to your insurance company in case of errors in processing or if they are lost.

Since patients pay at the time of the session, it's important that you do not indicate on your claim form that you want benefits assigned to my office. That will result in a reimbursement check sent to me. When that happens, I notify you. I also void and return the check to your insurance company so they can reimburse you directly.

Sometimes it helps to put a cover letter clearly stating that you have paid for services and have included proof of payment and that the company should reimburse you directly (this can make it more likely that a person handle your claim, rather than it being machine-read). Superbills for patients who pay via credit card will indicate that balances have been paid.

Please feel free to contact me to discuss any questions or concerns you may have about insurance and fees.