INSURANCE QUESTIONS

While I am out-of-network with all insurance panels, I will provide you with a receipt of services for you to submit to your insurance company for any out-of-network mental health benefits you may be eligible for.


This guide is provided to assist you with calling your insurance company to check on your out-of-network benefits. 


Payment:

At each session payment is due, unless another payment plan has been established. Thus, the client will pay their fee with cash or check. 


How to check your out-of-network coverage and possible out-of-network benefits:

Plan for 15-30 minutes of your time available to call your insurance company

Make sure to have this information ready before your call:

Insurance card

Name, date of birth, address, phone number, or possibly social security number of the cardholder or person for whom the services are for

Pen and paper/notepad

Questions to ask:

Are there out-of-network benefits for this policy?

Do I have a mental or behavioral health policy with out-of-network benefits?

What are the requirements to use out-of-network benefits?

Is prior authorization required?

Is a referral required from my primary care physician?

Do I have an out-of-network deductible?

If yes:

What is my out-of-network deductible?

How much of my out-of-network deductible has been met?

What is the start date of the calendar year my out-of-network policy is based on?

In addition, ask the representative if your policy covers these services (use the CPT codes provided below). How much is the insurance company’s “usual and customary fee” and what percentage do they cover?


CPT Code for Individual Therapy: 50 minutes, 90837 


Other questions to ask:

Is there a session limit?

If yes:

What is the session limit?

How many sessions do I have left?

What percentage of services is covered/what is my co-insurance? 

At the end of the call make sure to have:

Date/time you called

Representative’s name

Reference number for the call

Information that will be provided on your requested receipt of payment:

Provider’s name

Provider’s NPI

Provider’s license number

Federal Tax ID number

DSM-5 and ICD-10 diagnosis codes

CPT or Procedure codes


Although I do not accept Medicare, I will print a receipt of service which you can submit for reimbursement. Here is a link to instructions and the Medicare Part B Claim Form: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1490S-ENGLISH-Instructions-PartB.pdf

This guide is provided to assist you with calling your insurance company to check on your out-of-network benefits. Dr. Amanda Aster, Psy.D. is not responsible for the information obtained using this guide.

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