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Insurance

Out-of-Network Information

Counseling Creations is currently moving to Out-of-Network Insurance for most Insurance companies.  If you have Out-of-Network insurance benefits, we will provide a superbill so that your insurance can reimburse you.  Current clients will be notified if the change includes their insurance company.  Advance notice will be given to all current clients who are using insurance benefits if their insurance is moving to Out-of-Network status. 

For new clients, we are now accepting self pay, or clients who can use Out-of-Network benefits as we make the transition.  

Disclaimer:  Counseling Creations can use Out-of-Network benefits with ALL insurance companies. Although we do not take medicare, we can print a receipt that you can submit to be reimbursed. 

The link to the instructions and the Medicare Part B Claim form is:

https://www.cms.gov/Medicare/Medicare

(copy and paste the link into your browser)

The information provided here is to help you navigate the process of communicating with your insurance company to see if you have Out-of-Network benefits, and how the payment process will work.  Counseling Creations will send an itemized receipt of payment for services upon request. It will be sent at the end of each month and include your provider's name, the provider's NPI, the provider's license number, the federal tax ID, and your diagnosis codes. It is the client's responsibility to send this receipt into the insurance company to be reimbursed.

What do I need to do?

*Locate the insurance member services phone number on the back of your card.

*Make sure this information is available before placing the call:

     - Insurance card

     - Name, date of birth, address, phone number of the cardholder and the person seeking therapy.

     - Pen and paper to write down your findings as well as a reference number for the call.

* Here are the questions to ask:

     - Are there Out-of-Network benefits for this policy?  (If none, you are done with the call.)

     - Do I have a mental or behavioral health policy with Out-of-Network benefits? (If none, you are done with the call.)

      - What are the requirements to use these benefits?

     - Is there a prior authorization required to use the benefits?

     - Do I need a referral from my primary care physician to use the benefits?

     -Do I have an Out-of-Network deductible?

          If yes: 

               What is the Out-of-Network deductible?

               How much of the Out-of-Network deductible has been met?

               What is the start date for the year for my out-of-network benefits?

               What percent of the fees are refunded for the therapy?

               You may also inquire about customary fee's and percent covered for these specific services:

                     90791 (First session diagnostics),

                     90837  (60 min individual counseling

                     90853 (Group therapy)

                     90846, 90847 (Family Therapy)

     -Is there a session limit?  If so what is it and how many do I have left?

     -If I see a counselor via telehealth will Out-of-Network benefits apply? Or does it have to be in office?

     -Can I have a reference number for this call?  (Write it down along with the name of the representative, and the date and time you called.

This information is provided to help you with gathering the information from the insurance company to check on the Out-of-Network benefits that can be used for therapy. Counseling Creations is not responsible for the information obtained using these instructions.

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