Insurance for Therapy - Momentum Psychology

Request an appointment by clicking here or by calling 704-444-0087

INSURANCE TIPS

INSURANCE CAN BE

SUCH A PAIN

Although we are out of network and can’t talk to your insurer, we want to help empower you to get the most out of your coverage.

That’s why we have recently partnered with Reimbursify so that you can easily submit your claims for out-of-network health insurance reimbursement. At this time, you can file your first claim for free. After that, it is $3.99 per filing.* Please note that this practice is completely private pay and is out-of-network with all insurance companies. Download the app to get started today.

You can also submit your claims through your insurer’s out-of-network claims system.

Please use the tips on this page to make the most of your out-of-network benefits.

Please note that due to certain federal requirements, we can’t correspond with your insurer as an out-of-network provider. We can’t provide additional documentation beyond what is provided automatically in Simple Practice for your superbills, and we can’t alter superbills or invoices.

We hope that this guide can help you to do so. Please note, however, that this is not legal advice. Please ask your lawyer, insurer or agent, or human resources representative if you have questions. Your insurer may have totally different steps to follow. This is only a recommendation if you don’t have other resources.

Some people are concerned about using their insurance to cover behavioral health services due to concerns over confidentiality with insurance companies especially professionals with licenses such as lawyers and physicians. We can’t advise you about whether or not to file for OON benefits. Please discuss this with your advisor or attorney.

Step 1. Find out if you have out-of-network coverage for insurance and what your benefits are.

Grab your insurance cards.

Most private health insurance plans provide some level of out-of-network reimbursement. If you see the terms, “POS,” “PPO,” “Tricare,” or “out-of-network” on your insurance card then you are likely eligible. If you see “HMO,” “Medicare,” or “Medicaid” on your card than you probably do not. If you see several numbers to call and one of them says “BH”, that stands for “Behavioral Health” so we’d recommend starting with that phone number. Call the number on the back of your insurance card or ask your human resources representative to be sure.

You can ask them the following questions:

“Do I have out-of-network coverage for behavioral health?” This question will tell you whether or not out-of-network therapy is covered by your insurance plan. You will need to review your plan details or talk to their customer service to figure out if you have any coverage.
“What is my deductible for out-of-network benefits?” This will tell you how much you need to pay out of pocket before they will start paying you back for some of the session cost. Deductibles vary widely depending on your insurance coverage. Even if you were originally not planning to use insurance, it might still be worth working towards meeting your deductible so you can get your money back when you meet that threshold amount.
“What percent do you cover?” It could be more or less, but the answer is often 50-80% of what they call “allowable” reimbursement. Basically, every insurance company has this secret number of what they will cover. So as an example, Momentum Psychology might provide a service to you for $225, but your insurance company will say, “Ok, got it. Our allowable reimbursement is based off of $170. So we’ll pay you 60% of $170 and not 60% of $225.” Why? Insurance companies have their way of setting up their systems, so we can’t answer that for you, but at the end of the day, in the above example, you’d still be getting a check for $102 back for each session – potentially cutting your cost for therapy sessions at MP down to $123 a session once you receive your reimbursement.
“What if they want to pay the provider directly?” Nope with a dash of nope sauce. (Thanks Exploding Kittens!)
Some insurance companies will ask to pay the provider directly.
We cannot accept any payments from insurance companies or communicate with them in any way. Often, they will contact the provider directly and ask to negotiate the fee or reimbursement. Sometimes they will send us checks.
We cannot return their calls or correspondence. We will never cash their checks.
Your provider will let you know if they call, but he or she can’t communicate with insurance companies directly.

Step 2. Follow Your Insurer’s OON Submission Guidelines or Use Reimbursify

Option 1

Find Out How to Submit OON Claims to Your Insurer

Look at your insurance card or check your insurance portal for information on how to file out-of-network claims through your insurer’s portal. Please note that you must submit these through your insurer’s out-of-network claim system. You can’t try to use in-network systems or it will likely be rejected.

Option 2

Download Reimbursify

Download the Reimbursify app on your phone.

We have subscribed to Reimbursify directly, so you can easily submit your claims for out-of-network health insurance reimbursement. At this time, you will get your first filing for free and then each filing is $3.99 afterward.

You can also go directly through your insurance company to submit your claims that way.

If you have any issues with reimbursement, please note that you will contact their customer support directly with any issues. Due to our status as an out-of-network provider, we can’t speak directly with your insurance company. Reimbursify will coordinate with you and direct you on what you need to do.

Step 3. Check your portal for your monthly superbill.

Every month, you will receive a document called a “superbill” automatically. This is basically a special kind of invoice that lists specific information on the type of service you received, by which clinician, and with what diagnosis. You can’t be covered by insurance without a diagnosis that they are willing to cover for. In accordance with ethical and legal requirements, your therapist must put the diagnosis that they believe best fits your presentation. However, if you have questions, your therapist can talk to you privately about what diagnosis would fit your experience

Your therapist will need to know you are wanting a superbill so they can make sure the copies you get have all the correct info it needs on it. The only way these can be altered is if there was a factual error.

Some insurance companies require information beyond diagnosis, NPI number, license number, session cost, and CPT codes. We don’t provide information that is beyond what is customary.

We also can’t edit superbills that have already been issued.

Many insurance companies will contact us directly to negotiate with us to accept a lower rate or send us checks directly. Please note if we receive this information, we will let you know, but we will never speak directly to your insurance company.

Your Superbill

Your superbill will look like this one. Most insurance companies will not take invoices.

To find out how to download your superbills, use the find or search feature on your pdf software and search for “superbill” on this Simple Practice Guide.

Step 4. Upload or fax your superbill to your insurer. If you’re using Reimbursify, upload to your app.

Yay for Reimbursify! They make this super easy for you. Once you upload a superbill for the first time (it takes about 2-5 minutes), you’re set.

After submitting for the first time, you can just click “clone” or duplicate and it’ll cut your submission time down to about 30 seconds.

If you have any questions, please contact their support team directly. We can’t help you with your submissions or technical problems.

WHEW! That’s it! WHEW! That’s it! WHEW! That’s it!

Now, you know how to submit your out-of-network claims through your insurer or Reimbursify.

Once you hit your deductible, your insurance company will start mailing reimbursement checks to your mailing address.

WANT MORE WAYS TO SAVE?

If you have a health savings account (HSA) plan, you may also be able to submit expenses that are not covered for reimbursement there. Usually, this will also require submission of your superbills. You can only submit expenses that are not covered by insurance.

If you have an HSA card, you can try to use that on your credit card authorization form, and our Client Coordinator will let you know if there are any problems.

LET’S GET STARTED!

Momentum Psychology’s resources are for informational purposes only and are not intended to assess, diagnose, or treat any medical and/or mental health disease or condition. Our resources do not imply nor establish any type of therapist-client relationship. The information should not be considered a substitute for consultation with a qualified mental health or medical provider who could best evaluate and advise based on a careful evaluation. Nothing provided on this page is legal, insurance, or financial advice. You should discuss any concerns about your insurance, finances, or reimbursements with a financial, insurance, or legal advisor.

INSURANCE TIPS

INSURANCE CAN BE

SUCH A PAIN

Your Superbill

Learn About Charlotte, NC