We have tried to cover answers to all the insurance questions that we get from clients. If we missed something, please do not hesitate to ask your therapist.
We have chosen to remain an “out-of-network” provider for all insurance companies. In our experience, this allows us to provide a higher quality of care, independent from insurance-based rules or decisions.
It is your choice whether you would like to apply for insurance reimbursement or not. If you decide to do so, we provide a “super-bill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the super-bill to your insurance company for reimbursement.
Please note that we do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.
PAYMENT, INVOICES, AND SUPERBILLS
Also, please note that:
Payment for therapy is due when the therapy takes place. Using our online system (called Simple Practice), your credit card will be charged automatically at midnight on the day of your session.
You will automatically receive a monthly "invoice for services" on the 1st day of the month for appointments during prior month. This invoice will NOT have a diagnosis and other information necessary for submission to your insurance company.
You can request for a monthly Superbill as well, which can also be automatically generated on the 1st day of the month for the prior month's appointments. This will have all the appropriate insurance documentation. Some clients prefer to request the Superbill as needed or once per year. Also, some clients chose not to submit to the insurance company in which case a Superbill will NOT be created.
You can log into the online portal and download your invoices and/or Superbills at your convenience.
DIAGNOSIS IN COUPLES THERAPY:
For couples therapy, most insurance companies will reimburse for therapy involving two people if one person has been given a diagnosis. We should have a discussion to make sure the appropriate partner is provided with a diagnosis. Your therapist will be able to discuss this with you in advance of making an official diagnosis.
QUESTIONS TO ASK YOUR INSURANCE PROVIDER:
To find out more about your coverage, call your provider, get the name of the person you are speaking to, and ask the following questions:
Does my policy cover out-of-network outpatient psychotherapy?
CPT CODES: If yes, what is the reimbursement for out-of-network psychotherapy services for the following CPT codes: 90834, 90837, 90847.
What is the reimbursement rate for telehealth CPT codes, 90834-95, 90837-95, and 90847-95?
Your insurance company will understand what a “CPT code” is, and whether they reimburse for these specific codes.
Is there a maximum number of psychotherapy sessions for which they will provide reimbursement?
DIAGNOSIS CODES: Will the insurance company reimburse for the diagnoses which you have discussed with your therapist?
% REIMBURSED: If your insurance company reimburses a percentage of the cost, what is that percentage, and what is the maximum cost per session they are allowing?
For instance, they may reimburse 70% of a psychotherapy session (CPT code 90837), but assume that the maximum rate of the psychotherapy session is only $120 (instead of my actual rate). This would mean the client would be reimbursed $84 per session. Another insurance company, however, may only reimburse 50%, but allow a $250 hourly rate, meaning that the client would be reimbursed $125 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.
Is a doctor’s referral required and/or is pre-authorization required? What is the name and number of the person to be contacted for pre-authorization?
DEDUCTIBLE: Is there a deductible and how much is it? Is it a yearly deductible?
How much of the deductible do I have left over to meet?
ADMINISTRATIVE: What is the address of the office where I should send my claims? To whose attention is the claim to be sent?
HSA AND FSA ACCOUNTS:
Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.
LOWER FEE OPTIONS:
We understand that financial concerns or limitations in your insurance coverage may lead you to use an in-network provider. Also, there are local non-profit agencies that provide low-cost counseling services. Some good sources for finding out about these services are NAMI and Open Counseling.