Friday

So You Want to Bill Insurance (as a client)

If you plan to use insurance benefits for mental health, you might want to read this article first. What Your Therapist Hasn't Told You About Using Insurance.  Go ahead, this can wait!

Okay, if you still want to use insurance benefits for mental health, here's how to do best that.

How To Bill For Therapy (In-Network or HMO)


1. Confirm your benefits
Some clients are surprised to learn that their insurance doesn't cover therapy, or only covers a few sessions, or requires a high co-pay or deductible. Some clients at our nonprofit have insurance but still choose the nonprofit because in the long run, it is less money. Be certain of your benefits before you start. Document everything in case you need to challenge them later.

2. You will need a list of therapists
...who are approved by your insurer. Use google or yelp to weed out the ones that are a bad fit for your. Narrow it down to a few and then contact them to see if they have any openings. Confirm your chosen therapist is still "In-Network" with your insurance, because sometimes those lists are outdated and you don't want to work this hard to find out they aren't covered.

3. Follow the therapists instructions
An in-network therapist is under contract with your insurance and therefore should be able to take it from here. Each insurance company has a unique billing process, allowable amount and treatment plan requirement. I couldn't cover them all here. In-network therapists might collect a deductible amount or co-pay. Double check that ahead of time with your insurance company as well as your therapist so there are no surprises. 


When possible, I highly recommend you utilize your PPO and find an out-of-network therapist. This gives you far more freedom of choice- and finding a therapist who "clicks" with you is very important to therapeutic success. "Goodness of fit" is a big deal, as is specific training and experience relevant to your needs.

How To Bill For Therapy (Out Of Network)

1. Confirm your benefits.
Once you have identified your therapist of choice (freedom!), and their fee, call the number on the back of your insurance card. Ask to confirm your out of network therapy benefits. The medical billing code for individual therapy is 90837. Once they have told you your benefits- document their answer as well as the customer service representative's name or ID number in case you need to challenge them later.

2. Pay for therapy at time of service.
This means your therapist works for you (not the insurance) and any billing issues are between you and your insurance, and within your power to address.

3. Get a "Super Bill" from your therapist.
This is just a fancy name for documentation of sessions. It will include the therapist's license, NPI number, your billing codes and diagnoses codes. Mail this to the address provided by your insurer. Again, document all of this. Your reimbursement may require you to follow up and you will need to know what you sent and when.

4. Expect to wait.
A standard length of time of 30 days from receipt. I have seen clients wait longer. This is why your own records are very important. Keep track of sessions and charges that are accruing. Your therapist can also hep you by providing session summaries if you need.

5. When you receive payment, compare to notes
Your check should include session dates and charges, as well as what you were paid. Compare this to what you were promised. Sometimes there is a difference. Cross off session dates on your records as they are paid. It is common for insurers to "skip" some dates in repayment and you will need to be able to catch them because...

6. There is a "window" of appeals
If something is incorrect (or you don't receive a response) there is often a window of time for you to challenge the company. If that time lapses (sometimes 30 days, sometimes 6 months) your appeal will be considered "forfeit" and you might lose your leverage. If they skip a payment or pay incorrectly or fail to respond, do not allow more than 3 weeks to pass before you contact them. Ensure that they have each session date you sent. Even if all they say is "we are working on it"... document that as well. This protects you from any "lost" submissions on their end.


My hope is that most of this is unnecessary caution. There are plenty of clients who submit their Super Bills and get reimbursed without any headache. But for those who need a little more structure, I hope this helps provide you with steps that will make mental health more accessible.

Still hoping for an easier way,



6 comments:

  1. This is so helpful! Thanks from a young adult just getting into securing their own therapy for the first time!

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  2. Hi Krysta-

    Thanks for the post. I submitted my claim to my insurance company to reimburse me for my therapy sessions that I paid for out of pocket, as my psychotherapist does not accept insurance, but they rejected my claim saying that they didn't pay for the service of psychotherapy provided by an MD. Any thoughts on how to get around this? Any help would be appreciated.

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Thank you for taking the time to comment. Please note that this (being the internet) is not a confidential or secure way to contact me. If you wish to speak with me privately, please call me at 916-270-7413 or visit my site www.CounselingInRoseville.com