Find out what your medical insurance covers

Finding out what your insurance policy covers before getting mental health care is really important. Here is how we suggest you go about finding out what your medical insurance covers.

First, we want you to know that DCNE is an out of network provider for all insurance companies. This means that you pay DCNE for your services and then submit a claim with your insurance provider to get reimbursed. Most of our clients get reimbursed a portion of what they pay DCNE but some get no reimbursement. We suggest you call your insurance company and ask about your benefits before beginning treatment. We also accept health savings and flexible spending account forms of payment.

To see which services your medical insurance covers, you need to get information about your specific insurance plan. You can do that by going on the insurance provider’s website or calling them. Typically their phone number is on the back of your insurance card. What you will find is some sort of policy document that outlines which services your policy covers. But this does not mean what they will cover. This is where it gets a bit complicated.

You need to know what your deductible is for out of network coverage. That is the amount you have to pay first before your insurance will pay anything. It is important to look for the out of network coverage deductible because that is most likely different than the in network deductible.

Then you need to know your co-insurance rate. This is the percentage of the bill you will be required to cover after you have paid for your deductible. For example, if your co-insurance is 70% and the bill is $100, and you’ve met your deductible, then you’d pay 70% of $100, which is $70. The insurance would pick up the rest.

Then when you get services from DCNE, you’d pay us the full DCNE cost, get a superbill from DNCE for your care, and then follow the claim process from your medical insurance company to submit your claim. Once they review your claim they will reimburse you for whatever is covered by your insurance policy. Complicated, we know.

To get a better sense of what your insurance covers, call and ask them these questions, in addition to whatever questions you have:

1. What is my out of network deductible and have I met it yet?
   1. If you haven’t met it, ask how much you have already paid and how much you have left until you’ve met it.
2. What is my co-insurance rate?
3. What are my mental health benefits for out of network mental health services, including mental health counseling (CPT code 90834), neurofeedback (CPT codes 90901 or 90876) and mental health assessments (CPT code 90791)?
4. Do I need a physician referral for out of network mental health services?
5. How many sessions are covered? Per week? Per year?
6. How do I file a claim for out of network mental health services?

 

Thanks for hanging in there with this post. It is dense and technical but it is important that you get covered for your mental health care with DCNE by your insurance provider. If you have any questions or would like to schedule a free 15 minute consultation, contact us here. We’d love to hear from you.