As I noted in the Fees and Insurance section, I am not ‘In Network’ with any insurance companies. I take payment directly from you when I provide my services.
However, I do have software that can electronically submit charges to your insurance company on your behalf so you don’t have to do the paperwork.
I have included a list of questions to help you determine how well your insurance will reimburse you. You should contact your insurance before you undertake any voluntary procedure so you are not caught with any unexpected expenses.
Questions To Ask Your Insurance Provider:
- Do you have Out of Network (OON) coverage ?
- What is your OON deductible? (What amount needs to be paid out of your pocket before insurance kicks in?)
- Has your deductible been met yet?
- How is a provider’s allowable fee determined? (Usual and customary for the area? Or based off of Medicare rates?)
- What do they consider the maximum allowable reimbursable charge for each of the codes listed below?
- What percent of the maximum allowable do they cover? It usually runs anywhere from 50% to 80%
Your Insurance Company will want to know certain things about me:
- I will provide My TAX ID if necessary.
- The zip code of my primary office location: 10003
My usual Procedure (session) Codes:
- New Patient Intake (evaluation) session:
- 99205
- Follow-up sessions each require two codes:
- 99212 or 99213 (medical/symptom evaluation)
- Plus
- 90836 (45 minutes psychotherapy ‘add-on’)
- 99212 or 99213 (medical/symptom evaluation)
A Note on Deductibles and Timing:
Starting therapy towards the end of the year: If you have not yet reached your deductible, then starting therapy at the end of the year might cost you more money out of pocket, as most deductibles reset in January. If you have met your deductible, it’s a good time to start. And see how therapy feels to you. Because you will be covered (at least to some degree.)