Insurance
IllinoisI'm now in network with Medicare in Illinois! As a woman turning 60 this year, I am honored and happy to be able to provide high-quality care to elders, in my office in southern Illinois.
All other plans for patients coming to the Illinois office pay at time of session, and can submit to their insurances for reimbursement -- which I'm happy to help you figure out how to do. But check back, regularly as I'm applying to panels in Illinois and should have more listed here soon. |
MissouriIn Missouri I'm in-network with Anthem/BCBS.
All other plans for patients coming to the Missouri office pay at time of session, and can submit to their insurances for reimbursement -- which I'm happy to help you figure out how to do. |
Out-of-Network benefits for all other insurance plans: When using an insurance I'm not in network with, you will pay at time of session then submit to your insurance company yourself for reimbursement. You will likely want to know what percentage they will reimburse you for.
Call the number on the back of your insurance card for the Benefits Department, Member Services, or Customer Service and ask them the following questions, and any other question you need to know*:
*Ask These Questions:
1) What is your name and extension number? ___________________________
2) Does my policy cover Out-of-Network, Licensed Clinical Social Workers? ___yes ___no
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? ___yes ___no
4) Does my policy cover Individual Psychotherapy? (CPT code 90837) ___yes ___no
5) What mental health Diagnoses are NOT reimbursable? ____________________________
6) How many Sessions are covered per year? _______
7) What is the Lifetime Maximum for mental health benefits? $_____________
8) What is my Out-of-Network Deductible? $_________
9) What is the Allowed Amount of the fee? a. Individual session (My fee is $120, CPT code is 90837): $______
Many insurance companies will reimburse a percentage of the total fee paid. In order to know how much of the $120 fee you’ll be reimbursed you’ll need to know what that percentage is. Some plans reimburse 80 percent, some 50 percent, etc. Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number.
10) What percent of the Allowed Amount will be reimbursed? _______%
11) How do I file a claim? ______________________________________________________
Write down every answer you receive. 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.
*Please note that I am not an insurance expert; these are the questions that need to be asked, to the best of my understanding. However, you are encouraged to do your own research, and I am not liable in any way if this information does not tell you what you need to know.
This handy form has all of the above questions about out-of-network benefits, and more:
| outofnetworkbenefits.pdf |