We have tried to cover answers to all the insurance questions that we get from clients. If we missed something, please do not hesitate to ask your therapist.
We have chosen to remain an “out-of-network” provider for all insurance companies. In our experience, this allows us to provide the highest quality of care, independent from insurance-based rules or decisions.
It is your choice whether you would like to apply for insurance reimbursement or not. Usually insurance companies will pay a portion of your spending, depending on your policy. As such, 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.
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.
PAYMENT, INVOICES, AND SUPERBILLS
Also, please note that:
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.
QUESTIONS TO ASK YOUR INSURANCE PROVIDER
To find out more about your coverage, call your provider, get the name of the person you are speaking to, and ask the following questions:
1. OUT OF NETWORK:
Does my policy cover out-of-network outpatient psychotherapy?
2. CPT CODES FOR PSYCHOTHERAPY:
If yes, what is the reimbursement for out-of-network psychotherapy services for CPT Code 96130-95?
This code is for psychological testing evaluation services including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family members or caregivers. This code includes the provider’s time spent interpreting test results and patient data, preparing a clinical report, treatment planning, and clinical decision-making.
The "-95" for this code indicates telehealth.
3. DIAGNOSIS CODES:
Will the insurance company reimburse for the diagnoses which you have discussed with your therapist?
Please know a diagnosis code is different than a CPT code. A diagnosis code describes what the client (one partner in the couple) is struggling with.
If you do not have a diagnosis code yet, the most common diagnosis you could receive would be:
Autism Spectrum Disorder. ASD. F84. 0
Attention-deficit hyperactivity disorders. ADHD. F90-
If you do not meet the criteria of ASD or ADHD, you may qualify for an "Adjustment Disorder - DSM-5 309.9 (F43. 20)" which is an emotional or behavioral reaction to a stressful event or change in a person's life that typically lasts 3 months or less. Usually the "stressful event" is your relationship struggle. This is generally considered a mild diagnosis that is not intrinsic to the individual and will pass.
If a different diagnosis is appropriate, your therapist will discuss this with you.
4. STATE OF CALIFORNIA PROTECTIONS. 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.
SERVICES OUTSIDE OF CALIFORNIA:
Our therapists are only licensed to practice psychotherapy in California. Outside of California, they only provide coaching services. Coaches can NOT provide a medical diagnosis while psychotherapists can do so. Since most insurance companies do NOT reimburse for services unless a medical diagnosis is provided by a psychotherapist, it is unlikely that coaching will be reimbursed for non-California residents.
HSA AND FSA ACCOUNTS:
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.