Insurance & Claims
I do not participate with any insurance company panels, but my services are very often covered in full under your insurance policy's "out-of-network" benefits, your HSA (Health Savings Account) or your FSA (Flexible Spending Account). If you have no "out-of-network" benefits, you will not receive any reimbursement for my services. Some policies (both in- and out-of-network) have such high deductibles (the amount you must pay every year before benefits are paid) that you will never meet based on my costs alone, because once stabilized, my costs are quite reasonable. Remember that once stabilized you will need 4 appointments per year, at $165 each, $660 for the year.
Medication costs fall under a separate category of insurance coverage. All insurance companies are required to provide coverage for medication, but coverage varies from Plan to Plan. Know that each insurance company writes thousands of policy Plans, tailored to the Group buying it, with different coverage.
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It is prudent to check your coverage before an initial appointment is set, to avoid misunderstandings and disappointments. How to do this? The backside of your insurance card provides Customer Service contact information; most companies have both telephone and online methods of checking coverage. You want information about your "outpatient mental health services".
Key information to determine:
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what are your "out-of-network" benefits?
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do you have a "deductible" and if so, does it run according to the calendar year or a fiscal year?
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do you have a "Health Savings Account (HSA)" or similar plan in which a sum of money is set aside for you to spend on qualified health expenses?
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what does the Company pay for the specific services you need? You want the "reasonable and customary amounts allowed" in the 80203 zip code for the following procedure codes: 99205 plus 90833 for the initial consultation of 90 minutes; 99214 for 1/2 hour followup visits (most common followup visits); and 99214 plus 90833 for 1 hour followup visits (rare).
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how do you obtain Claim Forms, and what is the deadline for submitting claims?
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finally, if this is a telephone call, obtain a reference # for the information you were given
Following an appointment, I will provide you with a "Superbill" invoice that contains all the information required by insurance companies to submit a claim for reimbursement. My Superbill is attached to your company's Claim Form, and any reimbursement due you is sent directly to you.
For further information about health care insurance in general, including cost estimators for any and all health and dental procedures, I recommend https://www.fairhealthconsumer.org/