Insurance

It is important to call your insurance company to find out exactly what mental health services are
covered. All plans have certain rules, limits, and procedures. Sometimes a pre-authorization for services
is required and often a deductible needs to be met before any reimbursements. In addition, there may
be a limit to the number of visits allowed per year and a maximum amount of
allowed charges per year and in a lifetime.

The following are some helpful questions that individuals can ask their insurance company:

Do I have mental health benefits?
If yes, do I need to see someone on the insurance company provider list only or am I also covered for out-of-network providers?
If I have out-of-network coverage, do I need to meet a deductible before receiving any reimbursements?
If I have out-of-network coverage and a deductible needs to be met, how much is the deductible and how much of it have I already satisfied this year?
With out-of-network benefits being used, once the deductible has been met, what does the insurance company consider to be the usual and customary individual psychotherapy (code 90834) fee for a licensed psychologist in my geographical area and what percentage of that fee does the insurance company cover?
Do I have teletherapy benefits? If yes, what codes are necessary to submit to insurance (Modifier GT or 95, Location 11 or 02)? Are there any limits on this coverage?
How many sessions per calendar year does my plan cover? Please note: The number of sessions per calendar year, even if unlimited, is not a guarantee that the company will ultimately approve and/or cover this number of sessions.
Is there a maximum amount of charges allowed per year or in a lifetime?
Do I need pre-authorization from the insurance company or a referral or approval from my primary care physician before my first appointment?

Individuals without health insurance, mental health coverage, and/or out-of-network mental health coverage are encouraged to discuss their situation further with me.