Paying With Insurance

 

Can I get reimbursed for services?

As a licensed clinical social worker in private practice, I do not take insurance. However, I do provide you with a CMS-1500 or super bill at the end of every month. Some insurance companies will partially reimburse you for the fee you pay to me. Payment is due at the start of every session. 

How can I find this out?

Call the number on the back of your insurance card for the Benefits Department. Write down every answer you receive. Don't be intimidated. Ask for explanations of anything you don't understand. Ask to speak to a supervisor if you are not happy with the answers you are getting. You'll need careful records later if the company fails to follow through with what they've told you. Follow the questions in the order below. 

  1. What is your name and extension number?
  2. Does my policy cover out-of-network Licensed Clinical Social Workers? (I am licensed in Missouri, and my license number is 2015004223)
  3. My therapist is willing to provide a statement of Session Dates Attended, the CPT code, and the Diagnosis. Is this acceptable to the insurance company?
  4. Does my policy cover Individual Psychotherapy (CPT code 90834) for my child/adolescent?
  5. Are there any mental health diagnoses that are not reimbursable?
  6. How many sessions are covered per year?
  7. What is my lifetime maximum for mental health benefits?
  8. What is my Out of Network deductible? (This is the amount you have to pay before they start reimbursing you - and for some insurance companies, this can be prohibitively high)
  9. What is the Allowed Amount of Fee? 
  10. What percentage of the Allowed Amount will be reimbursed?
  11. How do I file a claim?
  12. What is the payment schedule? (ie How long does it take for them to process your paperwork and then reimburse you?)

Something to note:

Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid, or $80 for, say, a $100 individual session.

Other companies will substitute the $100 fee for what they deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you 80% of the “allowed amount” of the fee. You paid $100 for an individual session, but your insurance company only allows $60. Therefore, you will be reimbursed 80% of $60, or $48.

They may try to withhold this information from you. And actually, they are legally allowed to do so.  Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number. As a reminder, my fee is $165 per session.

Other things to consider:

  1. Insurance reimbursements can vary from month to month:
    • At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit.
    • In January of each year, you will not get any money back until your deductible is met. If you apply other family medical expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.
    • Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited.
  2. Your out-of-pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."
  3. You should ask your accountant about taking a medical tax deduction for psychotherapy.
  4. You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network therapy (called Preferred Provider Organization, or PPO).