Prospective Clients

Many of my clients utilize their insurance plans for therapy services as an out-of-network provider.  If you would like to use your insurance, the following questions will be helpful when calling your insurance company.

Call the number on the back of your insurance card for the Benefits Department. Write down every answer you receive. Don't be intimidated. Ask for explanations of anything you don't understand. Ask to speak to a supervisor if you are not happy with the answers you are getting. You'll need careful records later if the company fails to follow through with what they've told you.

1) What is your name and extension number?  ___________________________

2) Does my policy cover Out-of-Network, Licensed Clinical Social Workers?  ___ yes  ___no

3) My therapist is willing to provide a statement of session dates attended, the CPT code, and the Diagnosis. Is this acceptable to the insurance company?  ___yes  ___no

4) Does my policy cover: 45 minute Individual Psychotherapy? (CPT code 90834)  ___yes  ___no

60 minute Individual Therapy (CPT code 90837) ___yes  ___no

Family Psychotherapy (CPT code 90857) ___yes  ___no

Group Psychotherapy? (CPT code 90853) ___yes  ___no

5) What mental health Diagnoses are NOT reimbursable?  ____________________________

6) How many Sessions are covered per year?  _______

7) What is the Lifetime Maximum for mental health benefits?  $_____________

8) What is my Out-of-Network Deductible?  $_________

9) What is the Allowed Amount of the fee?  $_________

a. Individual session (Our typical fee is $120, CPT code is 90834):  $______

b. Group session (Our typical fee is $45, CPT code is 90853):  $_______

Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid, or $96 for a $120 individual session. Other companies will substitute the $120 fee for what they deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you 80% of the “allowed amount” of the fee. You paid $120 for an individual session, but your insurance company only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number.

10) What percent of the Allowed Amount will be reimbursed?  _______%

11) How do I file a claim?  ______________________________________________________

Many companies now make it very easy by providing a link to quickly upload your statements or receipts.

Health Savings Accounts, Flexible Spending Accounts, and all major credit cards accepted.

Cancellation Policy: 24-hour notice must be given, or the cost of a full session will be charged.

It is important to find a therapist with whom you feel comfortable; if you find we are not a good fit for whatever reason, I will happily refer you to a trusted local colleague.