OUT OF NETWORK: 
Does my policy cover out-of-network outpatient psychotherapy?

We are an insurance-friendly practice.

While we are an “out-of-network” provider, many of our clients are able to get a significant portion of their fees reimbursed, depending on their insurance plan.
 

Being out-of-network allows us to offer the highest quality of care without being limited by insurance company rules or restrictions.
 

You have the option to apply for reimbursement — and if you have out-of-network coverage, you should receive money back from your insurance company.

The exact amount will depend on the details of your policy.

CPT CODES FOR PSYCHOTHERAPY:

If the policy does cover out-of-network, what CPT codes will be used?
 

• 90791-95 — Psychiatric diagnostic evaluation (initial intake session)

• 96112-95 — Administration of developmental tests (assessment sessions)

• 90837-95 — Psychotherapy, 50 minutes (therapy that's integrated in the assessment)
   

The "-95" modifier indicates that the service was provided via telehealth.

These are the codes most commonly used during your assessment process and should be provided to your insurance company for reimbursement inquiries.

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The "-95" for this code indicates telehealth.

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DIAGNOSIS CODES:

For the insurance company, how does my diagnosis figure into the equation?

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Insurance reimbursement is based on the CPT code (which describes the service provided), not the diagnosis code (which describes the condition being treated).

As long as a diagnosis is provided, and you have out-of-network coverage, you should receive some reimbursement based on the CPT code billed.​

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FILING WITH THE INSURANCE COMPANY:

Will you file an insurance claim for me?

 

If you decide to seek reimbursement, we provide a “superbill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the superbill to your insurance company for reimbursement.

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Please note that we do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.

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STATE OF CALIFORNIA PROTECTIONS. 

Is my insurance company required to cover an autism assessment?

 

California’s autism insurance bill, SB 946 (2012), Cal. Insurance Code § 10144.51 (2017)  and Cal. Health and Safety Code § 1374.73 (2017) require health insurance policies in California to provide coverage for behavioral health treatment for pervasive developmental disorder and autism.

 

This often includes assessment and diagnosis. The specifics of actual insurance coverage vary greatly between insurance providers and policies.

 

We highly recommend that you contact your insurance providers so that you fully understand the extent and limitations of your coverage.​

 

​HSA AND FSA ACCOUNTS:

​Can I use my HSA or FSA account?

 

Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.
 

PAYMENT, INVOICES, AND SUPERBILLS
When is payment due?

 

Payment for therapy is due when the therapy takes place. Using our online system (called Simple Practice), your credit card will be charged automatically at midnight on the day of your session.

 

You will automatically receive a monthly "invoice for services" on the 1st day of the month for appointments during the prior month. This invoice will NOT have a diagnosis and other information necessary for submission to your insurance company.

 

You can request for a monthly Superbill as well, which can also be automatically generated on the 1st day of the month for the prior month's appointments. This will have all the appropriate insurance documentation. Some clients prefer to request the Superbill as needed or once per year. Also, some clients chose not to submit to the insurance company in which case a Superbill will NOT be created.

 

You can log into the online portal and download your invoices and/or Superbills at your convenience.

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SERVICES OUTSIDE OF CALIFORNIA
If I get coaching services from you, will the insurance company reimburse me?

 

Please be aware that our therapists are licensed to practice psychotherapy exclusively in California.

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If you live outside of California, we would be glad to provide neurodiverse-informed coaching services but can NOT provide an assessment. 

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Also, please be aware that most insurance companies do not reimburse for coaching. 

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