QUESTIONS THAT MIGHT BE HELPFUL TO ASK YOUR INSURANCE COMPANY ABOUT YOUR OUT-OF-NETWORK COVERAGE
DO I HAVE OUT-OF-NETWORK MENTAL HEALTH INSURANCE BENEFITS?
This will let you know if you’re able to have your sessions covered through your insurer.
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WHAT IS MY OUT-OF-NETWORK DEDUCTIBLE?
This will let you know how much money you need to spend out-of-network before your benefits will kick in. I have seen plans with deductibles as low as $500 and as high as $3,000.
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HOW MUCH OF MY OUT-OF-NETWORK DEDUCTIBLE HAS ALREADY BEEN MET?
Finding out how much you’ve already spent will let you know how much more you need to spend to meet your out-of-network deductible. For example, if your out-of-network deductible is $1,000 and you’ve already spent $850, you will only need to spend $150 more before your out-of-network benefits kick in.
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WHAT IS MY REIMBURSEMENT RATE?
This will tell you how much you will receive back from your insurance company after you submit your superbills. Intake (billing code 90791) and future sessions (billing codes 90837 for 60 min., 90834 for 45 min., 90847 for family sessions, and 90853 for groups).
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WHAT IS MY POLICY PERIOD?
A “calendar year” policy starts on January 1 and ends on December 31. A “policy year” policy is a 12-month policy that will have a different start and end date, for example, August 1-July 31. It is important to determine your policy period when factoring in how much more time you have to meet your deductible.
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DOES MY PLAN LIMIT HOW MANY SESSIONS PER CALENDAR YEAR I CAN HAVE? IF SO, WHAT IS THE LIMIT?
This information will let you know how many sessions insurance is willing to cover through your Out-Of-Network benefits. Any session past this limit will be self-pay and not considered reimbursable.
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WHAT IS MY CO-INSURANCE OR CO-PAY?
This is the percentage or amount that you will be responsible for. If your out-of-network coverage specifies a copayment amount, e.g., $50, that is the amount you owe once you meet your deductible (if applicable), and insurance will cover the remainder. If you have a coinsurance percentage, e.g., 20%, this is the amount you will be responsible for.
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HOW DO I SUBMIT FOR REIMBURSEMENT?
Typically, you will need to obtain a Superbill (which we can email monthly or is accessible through our client portal) and submit it to your insurance company. A Superbill is a document that includes dates of service, a diagnosis code, a CPT code, and your therapist’s NPI and EINs. Insurance companies have different ways to submit the Superbill, typically through their website, snail mail, or fax.
You can also use Reimbursify, an app that can submit Superbills on your behalf (they charge per claim and handle all backend work so that you do not have to navigate the insurance system yourself).
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HOW LONG DO I HAVE TO SUBMIT MY SUBERBILL?
There is a time period after the “date of service” to submit the Superbill to your insurance company for reimbursement. So far, I’ve seen this range from 90-180 days. Make sure you find out how much time you have to submit the Superbill after “the date of service” when calling your insurance company.
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WHY PEOPLE MAY CHOOSE NOT TO SUBMIT TO INSURANCE;
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REQUIRED DIAGNOSIS OF A MENTAL ILLNESS
Insurance companies require a diagnosis before they will agree to cover all or part of your treatment. The rule is that insurance companies only pay for services that are considered “medically necessary.” This means that to utilize your medical insurance for mental health treatment, your provider will have to submit a diagnosis. Additionally, the clinician must prove that your mental health condition is affecting your health and overall functioning daily.
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YOUR TREATMENT WILL BECOME A PRE-EXISTING CONDITION ON YOUR RECORD
Any documented mental health treatment that is filed through your insurance will go on your permanent medical record. Entities that may have access to your record will see your medical history.