We are not providers on insurance plans but most of our clients with private insurance are able to obtain reimbursement for our services. You are responsible for payment upon each visit and we provide you with an invoice to be submitted to your insurance company for reimbursement. Please call the telephone number on the back of your insurance card and ask a case manager what your out-of-network mental health benefits are. The CPT (procedure) code for the initial 60 minute evaluation is 90791 and the CPT code for the 45 minute follow-up sessions are 90834. Ask if you have a deductible, and if so, how much.
We take many calls from prospective clients who are frustrated that they cannot find an in-network provider who is experienced in Cognitive Behavior Therapy. They find that these providers claim to have CBT training but their approach tends to be more of an eclectic mix of treatment modalities. Many of these providers have taken a workshop or been introduced to CBT but have not had extensive training in graduate and post-graduate programs. Thus, people are forced to go outside of their network to obtain expert care. Sometimes, deductibles are too high or reimbursement rates are not sufficient enough to allow people to utilize these out-of-network services.
What many people do not realize is that they can request something called a single case or ad hoc agreement in which the insurance company agrees to pay an out-of-network doctor’s fee in full if there are no experts available in network. When you purchase insurance, you pay for a service; in this case it’s a mental health service. If the insurance company cannot provide you with a doctor who can help you, then they have collected your money without being able to deliver a worthwhile service. If you purchase cable and they only deliver to you foreign language channels, you would demand that they give you what you paid for. With a single case agreement, you are requesting that they pay your out of network doctor’s fees. We have seen many clients through this process and they have received the treatment that they otherwise could not have afforded.
