in-network Health Insurance
I am in-network with a limited number of health insurance companies and my participation can vary by state. If you have health insurance and wish to use it to pay for all or a portion of my services please include coverage details when you contact me so that I can clarify my provider status with your insurer/state.
Out-of-Network health Insurance
Many insurance plans provide out-of-network coverage. This means that you can see any provider of your choice and be reimbursed all or a significant portion of their fee. I provide courtesy billing for individuals using their out-of-network benefits. You are expected to provide full payment at the beginning of each session and I then submit claims to insurance on your behalf so that you can be reimbursed by your insurance plan.
To learn more about your out-of-network benefits contact the phone number on the back of your insurance card and ask the following questions:
1. What is the effective date of my plan? When does it renew?
2. Do I have out-of-network coverage for outpatient mental/behavioral health services? if the answer is no then you must see in-network providers only. If yes, then ask:
3. Do I have a deductible for outpatient mental/behavioral health services? What is the yearly amount? What amount has been met up to date?
4. Once my deductible is met, what will my co-insurance responsibility be? (co-insurance is the amount you are expected to pay out-of-pocket. For example, if your insurance covers 80% of out-of-network costs then you would be responsible for paying for 20% of each session fee).
5. Is there a maximum amount that my plan will reimburse for the following CPT codes: 90791 (initial session)? 90834 (ongoing sessions)?
6. Is there a limit on the number of out-of-network outpatient mental/behavioral health sessions I can attend per year?
7. Do I require a referral from an in-network provider to see an out-of-network outpatient mental/behavioral health provider?
8. Do I require an authorization number/code to use my out-of-network outpatient mental/behavioral health benefits? If yes, please provide me with said authorization information.
9. What is the health modifier that should be included in billing (it may be GT or 95, or another code)?
10. What payor I.D. should out-of-network outpatient mental/behavioral health claims be sent to?
11. Lastly, always request a call confirmation/reference number for your records in the event that there is an issue with processing of your reimbursement by insurance.