Checking Your Insurance Coverage
Updated February 15, 2022
Because I am a licensed psychologist, many health insurance plans will help you pay for therapy and other services I offer.
Currently, I am only in-network with Aetna PPO and Tricare. I have done this to limit the administrative costs associated with being on an insurance panel. If I should decide to join others in the future, I will update this page.
For other health insurance plans, you may still be eligible for reimbursement for services from myself as an out-of-network provider.
Whether your insurance is with Aetna or another company, I strongly encourage you to inquire directly with your insurer about your financial responsibility so that you are not surprised by any fees. For Aetna subscribers, the most common source of frustration is discovering that you have a deductible to meet before they begin covering your services. For subscribers to other plans, the most common source of frustration is learning that out of network services are not covered.
To verify your benefits with your insurance company:
Call the customer service number indicated on the back of your insurance card.
Identify yourself with your name, member ID and DOB.
Ask them about your level of coverage for outpatient mental or behavioral health services. Be sure to clarify whether you are seeking the rate of coverage for out-of-network providers.
Some terms to be familiar with before your call:
Deductible - Some plans set an amount that their subscribers must pay out of pocket before they begin reimbursing for treatment services. If you have a $1000 deductible, for example, you must pay for $1000 of services (at a rate defined by your insurance company) before your insurance company begins covering the cost (as a BCBS subscriber) or reimbursing you (for when I am not in your network).
Copay - Some plans require you to pay a set fee, called a copay, for each visit. This amount varies by plan but could be between $20-$75. Copays apply to plans with and without annual deductibles.
Coinsurance - Some plans require you to pay a set percentage of the billed service. Again, this amount varies by plan but could be between 10% to 30%.
CPT Service Code - Medicare has developed a standard set of reference numbers for various medical procedures. The two codes to know with regard to therapy are: 90791 (Initial diagnostic interview) and 90837 (60m Psychotherapy).
In-network - Treatment providers who apply and are accepted to be on an insurance panel are known as in-network. They agree to abide by a set of policies and procedures, to accept a negotiated rate for covered services, and to file claims on behalf of the patient.
Out-of-network - Treatment providers are called out-of-network when they are not on a given insurance company's panel.
How Payment Works with Insurance
Plans in Which I’m Paneled
If you carry Aetna or Tricare, I bear the responsibility of filing claims on your behalf. You are responsible for the copay on the day of service. If it isn’t clear from your research or mine what you owe, I will file a claim for the full charge and let the insurance company report back your actual responsibility (which typically takes 1-7 days), at which point I will charge you for either your copay, coinsurance or the insurance-contracted rate (if you are still subject to the deductible).
Other Insurance Plans
If you have another insurance plan, you will be responsible for my full fee on the day of service.
If you are interested in filing for out of network reimbursement, Simple Practice will automatically generate a “superbill” for you on a monthly basis (arrives on 10th day of month). This document has all of the information needed for reimbursement, including diagnostic and procedure codes, specific service dates and charges, and my license credentials. You can access this document via the Client Portal. Unless we discuss otherwise, you bear the responsibility to submit this independently using your insurance company’s standard procedures.
