Learn about Out-Of-Network benefits:

Look at your “Summary of Benefits” in your member information packet and call your insurance company’s mental health phone number listed or the general number.

*Be advised that if you use this benefit for reimbursement from your insurance company, then your psychiatric diagnosis and treatment information become a part of your insurance company’s record.

Ask:

  • What is my out-of-network deductible for outpatient mental health?

  • What information from the Psychologist is required from my psychologist visit (i.e., Superbill with Psychiatric Diagnosis and CPT Codes with Telehealth Modifier code -95 or Place of Service (POS) -10):

    • CPT Codes:

      • Initial Evaluation 90791

      • 50-minute session 90834

      • 60-minute session 90837 for EMDR

    • Telehealth Modifier Code 95:

      • Initial Evaluation 90791-95

      • 50-minute session 90834-95

      • 60-minute session 90837-95

  • Is Telehealth and Telepsychology (i.e., HIPAA-compliant video conferencing) reimbursable (i.e., CPT modifier code -95 or POS -10).

  • Is Equine Assisted Psychotherapy (EAP) and Equine Assisted Learning (EAL) reimbursable? There are separate fees for the Psychologist, Equine Specialist and Barn use for EAGALA and O.K. Corral team sessions. Is only the psychologist’s mental health treatment fee for service reimbursable?

  • How much of my deductible has been met this year?

  • What is my out-of-network coinsurance for outpatient mental health?

  •    Do I need a referral from an in-network provider to see someone out-of-network?

  • What types of Behavioral Health services are NOT reimbursable?

  •   How do I securely submit my claim form for reimbursement?

  • How am I reimbursed for payment (i.e., a check in the mail, etc.)? How much will I be reimbursed for?

Understandably, there are pros and cons to using insurance for behavioral health treatment. It is an individual decision each person makes in light of personal values, needs, and privacy. Taking care of your psychological health is a worthy lifetime investment in you and loved-ones.

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