The choice of paying out of pocket for services versus billing insurance is an important one and should be made in an informed manner. If you want to consider billing insurance for your therapy, here are some important things to know:
- I am happy to bill any insurance company as an "out of plan provider." I am not a "panel provider" for any particular company.
- Billing insurance requires that you have a diagnosis of a mental health disorder. If you do not have a diagnosis already, I can do assessment and diagnosis.
- Insurance companies typically cover individual therapy, which can include sessions with another person present when that person's presence is necessary to address the issue at hand. Insurance companies typically do not cover "couples' therapy," but they will usually cover "family therapy." Insurance companies do not cover mediation services, although some EAP programs have mediation benefits.
- Even if your treatment is covered by insurance, they do not pay for sessions that you schedule but miss.
- I use an online billing service and we bill electronically whenever possible.
If you would like to check your benefits prior to setting up an appointment, you can call your insurance provider (listed on the back of your card). They will ask you for the following information:
- Your full name, date of birth, and address.
- Your individual ID number and the group ID number.
The questions to ask include:
- Do I have mental health benefits?
- Am I covered for out of network providers?
- Do I need "preauthorization" prior to beginning treatment?
- Do I have a deductible?
- When does the plan year start?
- How much of my deductible has been satisfied so far this year?
- What is the benefit (how much will the insurance plan pay, and how much will I have to pay)?
- Is there a limit to the number of sessions I can have?
- What is my annual out-of-pocket maximum?
This information will help you make an informed decision about whether you want to bill insurance for your therapy.
Please note that you will owe out-of-pocket for any sessions or fees not covered by insurance.