How to determine my insurance benefits?
In order to provide you with the highest quality of care, Psych Associates is an “out-of-network provider.” This means that Dr. Cline and his staff are not in-network with any health insurance companies. Since we do not directly bill health insurance plans, we expect your payment for our services up front at the time of your visit. However, if you do have health insurance coverage, you may be able to get reimbursed by your insurance company. This means that you would submit a form (from your health insurance company) along with an itemized receipt (we will happily provide one to you) to your insurance company, and then they will reimburse you for the money you spent (they will mail you a check). Please note that we value keeping your health records completely confidential, however if you are submitting a claim to your insurance company, we are then required to inform them of your diagnosis and type of treatment that we are providing.
Health insurance companies all vary in the coverage that they provide. In order to find out your specific benefits, we recommend that YOU CALL YOUR HEALTH INSURANCE COMPANY BEFORE YOUR FIRST VISIT (the number should be on the back of your card). When you make that call, we recommend that you ask the following questions:
- What are my medical/mental health benefits to see a psychologist/counselor?
- Do I need an authorization for mental health treatment and if so, how do I obtain it?
- Do I have out-of-network benefits for mental health?
- Do I have a deductible for mental health services and if so, how much?
- At what rate will I be reimbursed for mental health services (the usual range is 50% to 80%)?
- What is your claims address?
- How do I submit a claim?
You also may want to ask to what extent your health insurance plan reimburses for the following common services:
- CPT CODE: 90791 (Psychiatric Diagnostic Evaluation)
- CPT CODE: 90834 (45 Minute Individual Psychotherapy)
- CPT CODE: 90837 (60 Minute Individual Psychotherapy)
- CPT CODE: 96130 (Psychological testing evaluation services)
- CPT CODE: 96136 (Psychological test administration by physician)
- CPT CODE: 96138 (Psychological test administration by technician)
Do you take my insurance?
The simple answer is “we are out of network for most insurance carriers” but It’s actually more complicated than that. You are always welcome to submit a claim to your insurance carrier and we are happy to provide you with the superbill you need to do just that. Your insurance is an agreement between you and the insurance company. If I am in-network with an insurance company that simply means that I have also agreed to be in a relationship with the insurance company. They then use their relationships with the 2 of us to make money off of our relationship and in turn damage the care you receive. Here’s why:
- Health insurance companies dictate patient care. This is one of my biggest pet peeves! If a psychologist were to contract with a health insurance company, this creates a relationship whereby I am basically working for the company. This means that they can (and frequently do!) pressure me to only do certain treatments, limit the scope of our work to only doing the minimum, and limit the number of sessions. They also can refuse to pay me for performing certain services, which I (being the expert and the one who actually knows the patient) feel the patient needs. The insurance company’s involvement often leads to less than optimal care and unhappy, unhealthy patients!
- Health insurance companies are nosey. This is especially relevant when it comes to mental health care. If a doctor participates with health insurance companies, this means that they are required to release sensitive patient mental health information to them. Many folks do not necessarily want all of their confidential mental health information to be publicly available, but this is what the health insurance company mandates. Once they know the details about a patient’s diagnosis and treatment, they can start meddling in ways that limit your care!
- Insurance companies do not pay doctors very well. This means that in order to avoid going out of business, many doctors need to see more and more patients in shorter and shorter periods of time. They are forced to over-schedule appointments, leading to very long wait times for patients. All of this leads to overworked, stressed out and unhappy doctors. And overworked, unhappy doctors leads to poor care and unhappy, unhealthy patients!
NOTE: While there are many issues with health insurance, I am NOT recommending that people go without coverage. It remains necessary given the current world of healthcare. I personally have health insurance and I do recommend that all people have at minimum “catastrophic” coverage.
How to file a claim with your insurance:
Sounds daunting right? It’s really not as bad as it sounds. The insurance company has a contract with you and needs to fulfill that contract so you will continue to renew with them. Here are the steps to getting reimbursed.
- Contact your insurance carrier to learn if there is a specific way they want the claim submitted (many allow you to easily complete forms on line).
- Provide the insurance company with a copy of the superbill or statement from Psych Associates
- Wait patiently. Most insurance carries want to keep their clients happy and will process these claims in 30-60 days. (They make providers wait MONTHS for reimbursement and offer even smaller amounts to “resolve the claim” quicker).