Insurance

Can I use my insurance?

As a Licensed Clinical Social Worker in private practice, I do not accept insurance. I made this decision for a number of reasons based on how I believe I can best serve my clients. 

Although I do not accept insurance, I am an Out-of-Network provider and can provide you with everything you will need to submit claims to your insurance company for reimbursement. (This includes License #, NPI, Tax ID, diagnosis code, service code, etc.)

How do I know if I will get reimbursed?

To find out if you are eligible for reimbursement, start by calling the phone number on the back of your insurance card. There is usually a specific phone number for members. If not, you may see an option for either customer service or behavioral health. Here is a list of things you will want to ask your insurance representative.

1. What are my out-of-network benefits for 45-minute individual psychotherapy via Telehealth? 

(CPT code 90834 modifier 95)? 

2. How much is my out-of-network deductible, and how much has already been satisfied?

3. What percentage of the service will be reimbursed?

***Note: My fee for a 50 minute individual session is $110. Insurance companies may cover a certain percentage of that session fee, for example 50% or 80% of the total cost. 

4.What is the allowed amount for this service (90834 modifier 95)?

 

***Note: Although my fee is $110, insurance companies may have a different "allowed amount" in which they will reimburse for this service. For example, if your allowed amount is $90, that is the amount they will reimburse.

 

***Note: If you are being reimbursed a certain percentage of the total cost, it is important to understand whether that percentage is of my fee per session ($110) or your allowed amount, (for example $90). 

5. Is there a limit on how many sessions will be reimbursed and/or session frequency?

6. Are there any diagnoses that are not covered? 

***Note: Each diagnosis has a specific code, for example Generalized Anxiety Disorder is coded F41.1. It is important to know if there are any diagnostic codes that will not be covered by your insurance company.

© 2018 by Madeline Leitner

MSW, LCSW