INSURANCE

Parenting On Call is a fee-for-service practice, meaning that payment is due at the time of service. As a licensed psychologist, I would be considered an Out-Of-Network provider for most insurance companies. This means that many patients can be reimbursed 50-80% of fees when using their out-of-network insurance benefits. To better understand what your insurance carrier might reimburse for out-of-network psychotherapy services, call your insurance company before scheduling an appointment or consultation. You may want to ask your insurance carrier the following:

  • Do I have out-of-network mental/behavioral health benefits? Typically an out-of-network plan is referred to as Preferred Provider Organization Plan (PPO) or Point-Of-Service Plan (POS).

  • Do I have an out-of-network deductible that has to be met first before I get reimbursed? Has any amount of my deductible been covered this year?

  • What do they reimburse for out-of-network psychotherapy services?

  •  Is there a maximum number of psychotherapy sessions they will reimburse?

  • What is my co-insurance amount? Co-insurances typically range between 20%-40% of the session cost. For example, if the cost of the session is $200 you will be reimbursed between $120-$160/session by your insurance company.

  •  What is the usual and customary rate covered by my insurance for the following CPT codes: 90791, 90834, 90837 (Your insurance company will understand what a “CPT code” is, and whether they reimburse for these specific codes).

  •  If the insurance reimburses a percentage of the cost, what is that percentage, and what is the maximum total cost per session they are allowing? For instance, they may reimburse 80% of an individual psychotherapy session (CPT code 90837) but assume that the total cost of the psychotherapy session is only $120 (instead of my actual rate). This would mean the client would be reimbursed $96 per session, after paying a rate of $250-$300 out of pocket. Another company, however, may only reimburse 50%, but allow a $220 hourly rate, meaning that the client would be reimbursed $110 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.