Is it possible I am eligible for partial reimbursement from my insurance plan for the sessions I have paid for or pay for in the future?
Yes. We urge you to contact your insurance provider to verify your specific benefits coverage (see below). Some clients have very low annual out-of-network deductibles ($500) while others have very high
deductibles ($12,000); in many cases, once annual deductibles are met, clients receive half back (between 10% and 70% reimbursement) for sessions based on "allowable rates." Clients with Anthem/Blue Cross, Humana, and United
Behavioral Health have all been able to obtain reimbursement.
What is an "allowable rate"?
This varies by plan, but broadling speaking is an amount set by your insurance provider relative to the type of provider by whom you are being treated. For example, the allowable rate for a psychologist might be $70, 100, or another amount for a 45-minute session. Often the allowable rate is lower than the rate we bill.
What do I need to ask when I call my insurance provider?
The questions you should ask include:
- What's my Out-of-Network deductible? (Dollar amount.)
- Must my Out-of-Network deductible be met before benefits apply? (Yes/No.)
- What is the reimbursement rate for outpatient psychotherapy? (Percentage.)
- Is preauthorization required for 60 or 90-minute psychotherapy sessions? (Yes/No.)
- What paperwork do I need to start a reimbursement claim, and where do I send it?
- Is preauthorization required for psychotherapy testing? (Yes/No.)
- Is preauthorization required for intensive outpatient therapy? (Yes/No.)
My insurance company said my plan requires Pre-Authorization or Pre-Certification. Can your office do that for me?
Yes. Because pre-authorization must be done by the provider, we are happy to complete the necessary paperwork. Please remit all materials to be completed to our reception team to be completed by our clinical staff at least 48 hours in advance of your first appointment.
I will need an itemized statement to send them for a reimbursement claim. Will you provide that?
Yes. We are happy to provide this type of statement upon your request in hard copy or electronic format.
Lower cost options are available for clients without insurance or who cannot get insurance reimbursement. Call to inquire.