I am an in-nework provider for Blue Cross Blue Shield and participating provider for Medicare. You are generally required to pay a co-pay or coinsurance at each visit.
I am an out-of-network provider for other insurance carriers. Please consult your plan to determine what your out-of-network benefits are. Most
plans usually require that you pay a certain deductible (the whole fee up to a dollar amount) and then pay a percentage of
the session fees after you have met your deductible amount. In most cases, I will file out of network claims for you as a courtesy.
If you use your insurance for payment or reimbursement for services, the company
requires that I provide them with a diagnosis. This is a medical diagnosis and
may (or may not) affect your future insurability/rates. Based on the diagnosis
that is provided, the company must decide that there is “medical necessity” for services, which means that your
symptoms must be severe enough or impairing your functioning to a large degree or else they will not authorize payment for
services. It is not legal or ethical for me to change your diagnosis in order to make it more severe or to increase likelihood
of payment or level of services. They also require a service code that describes
the length, type of session (e,g, initial interview, individual counseling, family counseling, testing). They may ask for
additional information about treatment as well.
Psychological testing usually requires
pre-certification for services. I will submit a form that lists the type of tests that I will be using, the reason why the
testing is being done, a diagnosis/and or a rule-out diagnosis. The insurance company will determine if they will pay for
testing, and if so, how many hours they will pay for. As described above, they
may limit or exclude certain diagnoses from payment. Please check with your plan about possible exclusions.
Please feel free to ask me any questions
you have about this information and/or contact your insurance company.
You always have the right to pay for services on your
own.
