Our clinics are not in-network with any insurance panels which means we don’t directly take insurance, but we can provide the information you would need to submit to your insurance company for any reimbursement that they may offer through your out-of-network benefits.

 

You can contact Member Services for your plan by calling the number on the back of your insurance card. Be sure to ask about mental health / behavioral health coverage (rather than medical), for out-of-network providers in an outpatient setting (rather than inpatient, residential, or drug/alcohol treatment facility).

 

Questions you can ask the insurance representative:

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1. Do I have a deductible for out-of-network mental health services, and if so, what is the remaining amount I would have to pay before my health plan starts to reimburse me for any fees I pay out-of-pocket?

 

2. Do I have a coinsurance for out-of-network mental health services (i.e. I pay 30%, the plan pays 70%)?

 

2. Is there a limit on the number of sessions my plan will cover per year?

 

3. Is there an out-of-pocket maximum for my plan, after which point the reimbursement total increases (i.e. $3500)?

 

4. Does this plan require pre-authorization for out-of-network therapy or psychiatry?

 

5. What is the policy year (i.e. Jan 1 - Dec 31) or when does the deductible and out-of-pocket maximum reset (usually is calendar year, resets on Jan 1)?

 

6. What is the reasonable and customary fee (the amount that the plan determines is the normal range of payment within a given geographic area) for CPT codes 90792 (intake), 99214 (medical visit), 90836 (also 38-52 min of therapy), 90833 (also 16-37 min of therapy), 90834 (only 38-52 min of therapy), 90847 (couples/family therapy)? In other words, what is the maximum per session covered? They may ask for your zip code in order to tell you how much maximum they would cover in your area for that code. In other words, what is the maximum per session covered?

 

For example, if your co-insurance is 30%, and if your visit is $495, but your insurance plan's reasonable and customary cost of the codes used in that visit totals $350, then they may only reimburse you 70% of $350 rather than 70% of $495. You would pay the full amount to the clinic, and the insurance company often sends a reimbursement check in the mail.

 

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