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Out of Network Insurance

Our practice is out-of-network with all insurance companies. Many clients are able to obtain reimbursement. We have prepared a list of questions for you to ask your insurance company about your coverage.  If you have out-of-network benefits, you will likely receive some reimbursement. Every plan is different, however, so it is important to check your specific coverage.  In some cases, an insurance company will approve coverage even if you don’t have out-of-network benefits. This may occur because you or your child need a specialized form of treatment that we offer and is difficult to find elsewhere.

Our administrative staff will be happy to assist you in submitting insurance claims. Please feel free to call either office for help.

Questions to ask your insurance company

Does my policy include an outpatient mental health benefit?

If yes:
· Does my policy cover a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC)?

If yes:
· Does my policy cover an out-of-network LCSW or LPC?

If yes:
· What percent of the fees will I be reimbursed for an out of network provider?

  • What are the maximum fees covered for the initial session – CPT code 90791?
  • What are the maximum fees covered for individual psychotherapy sessions – CPT code 90834?
  • Is family therapy covered – CPT code 90847 and if so, what are the maximum fees?
  • Are extended sessions covered – CPT code 90837 and if so, what are maximum fees?
  • How many sessions of psychotherapy are covered per year?
  • Is my mental health deductible part of, or separate from, my medical deductible?
  • What is my yearly mental health and/or medical deductible?
  • How much of my deductible have I met this year?
  • What is the procedure for reimbursement?
  • To whom should I mail or fax the receipts?
  • Once I mail in a receipt, how long before I receive a reimbursement check?
  • Do you require pre-approval or pre-certification of sessions?

If yes:
· Who must obtain the pre-approval or pre-certification?

  • How is this done?

 

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