What you need to know regarding insurance coverage and reimbursement:
Although I do not directly bill your insurance company, you may be reimbursed for part of the fee if you have a PPO that provides for “out of network” coverage. As a licensed Marriage and Family Therapist, I will provide you with a receipt with the necessary information to submit to your insurance company for reimbursement. If you meet the criterion of your insurance company, you may be reimbursed for part of the fee.
It is your decision whether to submit your claim(s) for mental health coverage. Please understand that disclosure of confidential information may be required by your insurance company to process your claims. Submitting the receipt that I provide you for reimbursement can entail some risk to confidentiality, privacy or future eligibility to obtain health or life insurance. Therefore it is important for each individual, couple or family to make an informed decision regarding future reimbursement.
Some clients decide to pay out of pocket, and others decide to pursue the matter to get more information.
Here are some questions you may want to ask your provider. I always recommend taking good notes with the date and the name of the person who was answering your questions.
- What is your name and extension number?
- Am I eligible to submit a claim for reimbursement myself rather than the provider submitting the claim?
- Do I need pre-authorization in order to be reimbursed?
- What is the rate of the reimbursement?
- What is the rate of reimbursement for a “non-preferred” or “out of network” provider?
- Is there a ” usual and customary fee” that is reimbursed? What is that specific fee?
- How much can I expect to be reimbursed per visit with an “out of network” provider?
- Is my reimbursed rate only for specific procedure codes or CPT?
- What procedure codes in my plan are not reimbursed?
- Does reimbursement require a DSM V diagnostic code?
- What specific DSM V codes are not reimbursable?
- In researching this topic, I find that licensed Marriage and Family Therapists often have strong beliefs on whether clients should submit claims or pay out of pocket.
My belief is that each individual, couple and family may have different needs, access to resources and/or financial concerns that should be taken into consideration before making an informed decision. Please feel free to call my confidential voice mail at 949-261-8299 if you have any additional questions.
Shellee Moore, LMFT
20 Corporate Park, Suite 215
Irvine, CA 92606