Village Wellness Family Counseling, P.C. – Blog

#mentalhealthmatters #outofnetwork #thousandoaks #timetotalk #TOVillageWellness #villagewellnessto #yougotthis agoura hills anxiety Anxiety anxious parents art therapy calabasas California childhood anxiety cognitive behavioral therapy Conejo Valley Coronavirus counseling COVID19 depression gun violence kids moms oak park parenting parenting support perinatal mood disorders person centered positive psychology postpartum postpartum anxiety postpartum depression postpartum rage psychotherapy school shooting self care simi valley solution focused suicide therapy thousand oaks TOstrong trauma westlake village

Lori Allen

, , , , , , , , ,

USING YOUR INSURANCE BENEFITS TO PAY FOR THERAPY

USING YOUR INSURANCE BENEFITS TO PAY FOR THERAPY

Nowadays most of us have some sort of medical insurance, which is great! However there are so many different plans, with different benefits, and different costs, that it can be confusing to navigate.

If you want to use your health insurance benefits to pay for therapy it’s important that you understand how health insurance works, and more importantly, what your health insurance plan covers. Knowledge is power people! When you actually understand the nuances of your plan, you may find that something you thought was out of reach, is very much possible!

While this article can’t give you exact answers on what your plan offers, it will provide a guide on what to ask your insurance company so that you know exactly what type of investment you can expect when starting treatment.

Understanding your health insurance plan

Insurance plans can look like alphabet soup. HMOs, PPOs, EPOs, POSs – all these acronyms stand for health insurance plans that are designed to meet different needs. They have different coverage depending on type and plan.

For the sake of this article we are going to focus on HMOs and PPOs.

Most HMO plans don’t have out of network providers, this means that you will need to go to an in-network provider if you want to use your benefits. Your insurance company should be able to provide you with a list of people that you can contact to see if they have openings and if they can help you accomplish your goals. Use our guide to help you navigate this decision.

If you have a PPO, you’re in luck. These plans provide the most flexibility, choice and privacy when it comes to using your benefits to cover the cost of treatment.

If you want to use your PPO plan to pay for your treatment you need to get clear on your benefits.

STEP 1: VERIFY YOUR BENEFITS We can get a general overview of your plan, but we always recommend that you call your insurance provider to confirm that we were given the correct information.

When you call, ask these questions:

Does my plan include out-of-network benefits for mental health care, specifically outpatient psychotherapy?

Do I have a deductible for out-of-network providers and if so what is the remaining amount I need to pay BEFORE my plan starts to reimburse me?

What is the maximum amount my plan will reimburse me for the following billing codes: 90791, 90837 and 90834, with a psychotherapist?

What percentage of the maximum allowed amount will my plan pay? **This final number is what you will be reimbursed.**

STEP 2: PAYMENT

If you find a provider who you want to work with, schedule your session! You will need to choose a payment method that works for you and is accepted by your provider. Please note that when utilizing your out-of-network benefits you will be required to pay the providers fee at the time of service. Your insurance company will reimburse you directly based on the information obtained in STEP 1.

STEP 3: CLAIMS

After your session, your provider will provide you with a superbill. This document has all the information you will need to submit to your insurance company for reimbursement. Be aware that this document will include a diagnosis code. It’s important that you understand that this diagnosis is required by insurance companies prior to paying for services.

If you need help using your out-of-network benefits let us know, and if you’re unsure why it’s beneficial to use an out-of-network provider, check out this article.

Lori Allen's avatar

Posted by:

Lori Allen