I take Preferred One health insurance and Medical Assistance (MA). I'm Out of Network with all other insurance agencies. I also work on a fee-for-service basis, meaning my clients can choose to pay out of pocket. You may have Out of Network mental health benefits that will allow you to be reimbursed for our sessions. If you're unclear how to go about deciphering how your insurance works, read below.
Diagnosis: When using insurance benefits, the insurance company requires a diagnosis for treatment. The diagnosis becomes a permanent part of your medical record. You and I will discuss your diagnosis and it will also be on your invoice for your session should you choose to submit claims for reimbursement to utilize your insurance benefits.
If you are not using insurance to pay for therapy, you do not have to meet criteria for a formal diagnosis to receive therapy, and have much more freedom to choose the issues you would like to focus on in therapy.
1. Contact - You can find the number to call on the back of your health insurance ID card 2. Keep Calm - Ask to speak with someone about your benefits – these are customer service agents who are trained to answer your questions calmly and politely. If they do not, ask to speak with someone else on their team or their manager. You deserve to have your questions answered in a respectful tone. If you don’t understand what the representative is telling you, keep asking until it becomes clear and ask them to explain it a different way if they can. Remember to keep your cool, these are just ordinary people and they don’t make the rules! You will get much better help if you can stay calm even when circumstances are difficult. 3. Benefits - Ask if “out of network” outpatient mental health benefits are covered as a part of your plan. If so, this means you will pay me directly and then send a claim to your insurance company along with an invoice from our session. Then the insurance company will send you a reimbursement check. 4. Rates - The insurance company rep may be able to tell you the rates that you will be reimbursed for my services. Some insurance companies don’t make this information available to their customer service reps, but it doesn’t hurt to ask. Ask what their reimbursement rate is for an LPC (Licensed Professional Counselor) in zip code 55112 for billing codes 90791, 90834 and 90837. These may not be the exact billing codes we use but it will give you a ballpark range. 5. Claims - Ask where you can find the claim form that you’ll need to submit for reimbursement, typically this is on the insurance company’s website. Ask for the fax number or mailing address to send your claim in and what supporting documentation you’ll need. 6. Other questions:
What is my deductible?
Do I have a copay or coinsurance?
Do I need a referral from my primary care provider (family doctor) before starting therapy?
Are there any other fees or information I should be aware of?
Deductible--the amount of money you pay each year to cover eligible medical expenses before your insurance policy starts paying. Copayment--one of the ways you share in your medical costs. You pay a flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest. Not all policies use copayments. Coinsurance--the amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%. Not all policies use coinsurance. In-network provider--a health care professional, hospital, or pharmacy that is part of a health plan’s network of preferred providers. These providers have negotiated a discount for their services in exchange for the insurance company sending more patients their way. Out-of-network provider--a health care professional, hospital, or pharmacy that is not part of a health plan's network of preferred providers.
1403 Silver Lake Rd., New Brighton, MN 55112 (appointments available in Oakdale, MN upon request)