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Are You Eligible For Insurance Reimbursement?

I’m not affiliated with any insurance panels. However, I’m happy to provide an invoice for services that you can submit to your insurance company.

If you have out-of-network benefits, you will likely get a percentage of your counseling fee reimbursed.

Please note three things when considering using your health insurance in general:

(1) Your counselor will be required to submit a mental health diagnosis that is significant enough to warrant coverage.  This diagnosis will become a permanent part of  your health record,

(2)You will have to pay down your annual deductible before your mental health benefits will kick in,

(3) Couples counseling is often not covered in mental health policies because it is not considered a medical health issue.  Be sure to call and ask if diagnosis Z63.0 is covered by your policy

 

 

To determine if you have out-of-network benefits, check your policy carefully.  Call to ask the following questions of your insurance company:

• Do I have mental health benefits?
• Do you pay for out-of-network providers?
• If so, how much does my plan cover for an out-of-network mental health provider? What percentage of the fee is covered per therapy session?
• Does my plan cover couples counseling? Ask specifically about diagnosis Z63.0.  Often the representative you talk to on the phone will say ‘yes, family counseling is included’.  They often don’t realize that they are referring to the CPT code, not the diagnosis. Then the claim finds its way to the claims department and gets denied because the diagnosis for couples counseling (Z63.0 Relational Distress with Intimate Partner) is not covered.
• How much is my deductible and has it been met?
• How many mental health sessions per calendar year does my insurance plan cover? Do you give me these upfront or do you require me to incrementally ask for more until I reach the maximum amount per year?
• When does my insurance coverage for a year begin/end? When do my benefits renew?
• Is approval required from my primary care physician before I see a therapist?
• What is your turn-around time for sending me a reimbursement?

The way that this works is that you pay me the counseling fee at the time of your session.

At the end of each month, I’ll send you a detailed invoice (called a superbill).

You submit this invoice along with a claim form directly to your insurance company.  It’s easy to do – you can fill it out online through your insurance company’s website.

Your insurance company will process your paperwork according to whatever you discover from asking the above questions.

The reimbursement check will be mailed directly to you, not to me.  In my experience, out of network benefits tend to reimburse 50-80% of the session price.

The benefit to using your insurance is to reduce out-of-pocket expenses (or reduce your deductible).

The reason that you may not want to involve your insurance company is that each claim requires that a mental health diagnosis be made. This diagnosis then becomes a part of your permanent health care record. This may lead to limitations, such as denial for quality life insurance or health insurance later on.

Additionally, since a mental health diagnosis must be made to obtain reimbursement, the insurance company has to know a lot of information about you to be covered. The insurance company can review all of your records at their discretion.