I am an “out of network” provider with insurance companies which means that I do not bill insurance companies directly. Your counseling sessions are likely eligible for reimbursement through your out-of-network, behavioral health insurance coverage, medical spending or health care savings accounts.
Most insurance plans provide “out of network” coverage which allows you to choose your own clinician, reimbursing you a percentage of the provider’s fee.
Below are a series of questions that are guidelines for you to use when speaking with your behavioral health insurance provider.
Questions you will Ask your Health Insurance provider regarding your “Out of Network Benefits”
- Does my policy have ‘out of network benefits’?
- Is there a deductible? If so, how much?
- How many sessions will my insurance policy cover?
- How much does my insurance company pay? 100%? 80%? Other?
- How are insurance claims with this ‘out of network’ provider submitted?
- How long does it take for a claim to be processed?
- What do I need to do? Do I need to complete a form, or can my therapist provide a receipt?
- In order to be reimbursed can he provide me with a: receipt with the date(s) of service, diagnosis, CPT code(s), license, Tax ID and NPI numbers that I can then submit? Can I submit online, or do I need to use snail mail?
- My counselor is William A. O’Herron, LCSW
- His NPI (National Provider #) is 184-142-8786. His License # is 00637
- The CPT (Current Procedural Terminology) codes that your insurance provider will be reviewing for these Family Therapy counseling sessions, aka couples counseling sessions, just so you have them, is: 90847
- This is the form that providers complete when they submit a claim on your behalf to the insurance company, just so you have it and know the information that is needed: CMS1500.pdf
- Go to my Forms tab for a fillable version of this form, again just so you have it