INSURANCE INFORMATION

I am part of the Blue Cross Blue Shield network and can bill your insurance for mental health services. Individual therapy is typically covered by insurance however, insurance plans may not cover sexual and relationship therapy. Before starting therapy, it's best to check with your insurance provider to see if these services are covered. If you have a different insurance provider and I am out-of-network, I can provide you with a Super Bill. This document can be used to seek reimbursement through your out-of-network coverage.

Few things to note -

HMO plans do not provide out-of-network coverage.
Relationship therapy may not be eligible for reimbursement through out-of-network benefits.
In most cases, your deductible has to be met before you are eligible for out-of-network reimbursement.

Coverage Criteria:

To use your mental health insurance benefits, you must have a clinical diagnosis as insurance companies require it to be a "medical necessity" for coverage. This necessity must be ongoing, not just at the initial session, and if you do not meet the criteria, insurance companies can deny coverage. Although insurance companies do not typically cover relationship therapy however your plan may cover "family therapy" which involves the individual with the mental health diagnosis bringing in a family member to work on treatment goals. Bringing a partner to sessions will only be covered if it is considered medically necessary. Additionally, certain insurance plans may not cover sexual health diagnoses, it all depends on your specific health insurance plan.

Kaur Counseling Group Process:

In conclusion, I am happy to bill your insurance for mental health services if you meet the clinical criteria required by the Diagnostic Statistical Manual and your insurance provider. It's important to note that providing false diagnoses to obtain insurance coverage is considered insurance fraud, and I do not engage in such practices. During our initial session, we'll assess whether you meet the clinical criteria for a mental health disorder. If you do, I'll be able to bill your insurance accordingly. If not, you will be responsible for the full cost of the session. Please keep in mind that if your insurance rejects your diagnosis, you will also be responsible for the full cost of the session.

NETWORK COVERAGE

Please note, we are unable to confirm coverage and it is the client's responsibility to confirm coverage prior to starting therapy. Clients are responsible for the cost of services rendered.

I want to ensure that you have all the information you need to make informed decisions about your mental health services. To help you navigate your insurance coverage, I have put together a list of questions to ask your insurance provider. I hope that this resource will be helpful to you in understanding your coverage and determining the best path forward. Please keep in mind that it is important for clients to confirm their insurance coverage prior to starting therapy and to be aware of the costs associated with services rendered.

IN-NETWORK
COVERAGE

Call the number on the back of your insurance card, some have a specific number for mental health benefits
Tell the representative that you would like to confirm that Kaur Counseling Group is an in-network provider for your BCBS insurance plan. For your reference, our group NPI # is
Confirm that BCBS covers your mental health benefits as well as your medical benefits.
If applicable, confirm that your mental health benefits, cover sexual health/functioning.
Ask to confirm that the most common billing codes are covered: these codes are 90791, 90837, 90847, 90846, 90839, and 90840. Confirm that these codes are covered for virtual coverage. Descriptors are written below.
Ask if you have a deductible you must meet prior to insurance covering session costs. Have you met the deductible? Once you meet the deductible what will your client's cost be?
Ask if you have a copay- is the copay applicable for virtual sessions?
Ask if you need any pre-authorization prior to starting services?
Are there limits to how many sessions you can have a year?

SMILING WOMAN ON COUCH LOOKING AT PHONE AND DRINKING COFFEE

OUT-OF-NETWORK COVERAGE

Will I be reimbursed for seeing a licensed clinical social worker (LCSW)?
How much of the fee is reimbursed for out-of-network providers?
What is my deductible for out-of-network benefits?
Have I met my deductible out-of-network benefits?
What paperwork do I need to complete to receive out-of-network benefits?
How long will it take to be reimbursed for sessions after I have submitted my claims for out-of-network benefits?
Is approval required from my primary care physician's out-of-network providers?
Are mental/behavioral health services (Current Procedural Terminology/CPT codes 90837 for individual therapy for 53 minutes, or 90847 for family/couples therapy for 53 minutes) covered by my out-of-network benefits?
For couples counseling, ask if Z Code “Z63.0, Relationship Distress With Spouse or Intimate Partner”, will be reimbursed.
If applicable, confirm that your mental health benefits, cover sexual health/functioning.