Insurance Reimbursement
Navigating the maze of health insurance claims can be daunting, but we’re here to help. Below are some tips to assist you in getting reimbursed for our services. First, ensure you have all necessary documentation, including itemized receipts and a detailed description of the services provided. Next, fill out any required insurance forms thoroughly and accurately.
It’s also helpful to contact your insurance company’s member services for specific instructions related to their reimbursement process, as procedures can vary widely between providers.
Remember, these tips serve as general guidelines; for tailored advice suited to your particular policy, please reach out directly to your health insurance provider’s member services. We’re committed to making this process as smooth as possible for you.
Tips to consider when filing for reimbursement
When navigating the intricacies of insurance, a little preparation goes a long way. Always have a pen and paper handy. Take note of the number you called, the names of the representatives you spoke to, and the date and time of your call. Make sure to jot down important details, including reference and case numbers. Patience is key, as the system can be complex and customer service representatives are working hard to assist you. Don’t hesitate to ask for clarification on anything you don’t understand, and always get a name and reference number for your records. These simple steps can help ensure that your interactions are as smooth and productive as possible.
Prep for your call with your provider
- Call the member services or customer service number located on the back of you member card.
- Select the option about benefits and/or eligibility and do your best to get a live person.
- When speaking to a live person, state that you are “looking to see an out-of- network provider” for “outpatient psychotherapy” and want to know your “out-of-network benefits for psychotherapeutic services”. You are not looking for inpatient services or medical services.
- They will then tell you what the benefits are. Write those down. If you do not have any out-of-network benefits, you will generally not be able to be reimbursed for the services.
Questions to ask
- Are the following codes are covered: (get the codes from them or your provider)
- Example
- 90837 Individual psychotherapy 54-60 minutes
- 90847: Couples therapy – If applicable
- Is a diagnosis required for reimbursement?
- Do they cover psychotherapy via telehealth or online therapy ?
- Is a Licensed Marriage and Family Therapist a covered provider? – You can give them mine if they need the number (about me page)
- How much will you be reimbursed?
- Is there a deductible?
- Write this information down. If applicable, ask them how much of your deductible has been met to date and what date does the deductible start/end (usually Jan 1 to Dec 31).
- Is there a maximum out-of-pocket limit and if so, once you reach that, what is the reimbursable amount and will they cover 100% after you reach that?
- Is any prior authorization, pre-certification, or approvals needed? Who needs to make these (doctor, the therapist, psychiatrist?)
- Is there a visit limit?
- How you get reimbursed. Do I need any special forms? Do I submit by paper, online?
- Within how many days after the date of service do you need to submit.
- Tell them you will be paying the provider up front and ask them how you make sure that the provider does not get paid. This is a common mistake that insurance companies make: paying me, and not you.
Other Points to Consider
When navigating the complexities of insurance, it’s essential to consider a few key points to ensure you receive the full benefits you deserve. While some insurance companies may initially direct you towards in-network providers, remember that you have the right to use your out-of-network (OON) benefits. You should not need to justify your choice to use OON benefits; insurers are obligated to provide comprehensive details about your coverage, including specific inquiries you may have.
If you encounter a representative who seems uninformed or uncooperative, don’t hesitate to request to speak with another representative. Additionally, be aware that some insurers have recently changed their policies regarding Telehealth services for OON benefits, sometimes requiring the use of specific platforms. Always advocate for your rights and ensure you fully understand your benefits before making a decision.