Cheatsheet for Inquiring About Your Insurance Benefits
No one likes surprises, especially when it comes to insurance and medical costs. To limit these undesirable surprises we recommend new clients contact their insurance to confirm their benefits BEFORE beginning services, this cheat sheet will help prepare you for that call. Please be advised Empower Family Therapy does not verify insurance benefits. It is the client’s responsibility to know and understand their insurance coverage.
For In Network coverage:
Call the number on the back of your insurance card, some have a specific number for mental health benefits
Tell the representative that you would like to confirm that Empower Family Therapy is an in network provider for your insurance plan. For your reference our group NPI # is 1538700273
Confirm that your insurnace plan covers your mental health benefits as well as your medical benefits. Ask if you have a carve out or if your plan requires a pre-authorization.
Some insurance plans have a Carve Out, which means that they contract out the mental health coverage to another company that we may not be in network with. If you have a carve out you may not know unless you ask. Others require a pre-authorization meaning your benefits may not be able ot be used until you complete an authorization- most do not allow backdating for these so it’s critical we know ahead of time.
Ask to confirm that the most common billing codes are covered: these codes are: 90791, 90837, 90847, 90846, 90832, and 90834). Confirm that these codes are covered for both in office and virtual coverage.
Ask if you have a deductible you must meet prior to insurance covering session cost. Have you met the deductible? Once you meet the deductible what will your client cost be?
Ask if you have a copay- is the copay applicable for office and virtual sessions?
For Out of Network:
If you have an insurance plan that we are not in network with, Empower Family Therapy provides clients with necessary documentation to obtain reimbursement from their insurance company. Clients can call the number on the back of their insurance card, and inquire about their out of network benefits, and the submission/reimbursement process. We gladly provide clients with a superbill (a receipt for paid therapy services) that they then submit to their insurance companies for reimbursement. Most of our clients who utilize their out of network benefits prefer to batch the submissions, and submit these claims monthly or quarterly rather than weekly to decrease their paperwork time.
Provide this information to your therapist or intake coordinator upon discussion of utilizing insurance benefits.