Insurance Questions

Do you accept insurance?

 

I accept most UHC (UnitedHealthcare) and HMSA (Hawaii's Blue Cross and Blue Shield) plans. I am a boutique-style private practice that seeks to offer high quality, individualized attention to each client and am firmly committed to each person’s privacy and confidentiality.  I can’t meet those goals being in-network with insurance companies. 

 

I can offer you a receipt ("Superbill") to submit for reimbursement if you have out-of-network benefit coverage.

 

If you don't take my insurance, can I be reimbursed for some of the fee?  

 

Possibly!  If you have health insurance you may have out-of-network, telehealth mental health coverage.  If you do, here is how it would work.  At the time of your session you would pay for your service ($140 for 60-minutes) directly to Sensitive Soul Therapy.  At the end of each month I will provide you with a receipt that you submit to your insurance company. 

 

If there is a deductible, the insurance company will apply the amount you paid to that number.  If you have met your deductible, or there is no deductible, the insurance company will reimburse you for some or all of your session fees.  

 

Please check with your insurance company before deciding to use your benefits.  I make no guarantee that you will receive reimbursement (or how much reimbursement) from your insurance company.  Every insurance company is different and every plan varies. 

 

How do I find out if I have Out-of-Network benefits?

 

Call the customer service number listed on the back of your insurance card.  Here are some questions you may want to ask:

 

  • Do I have out-of-network behavioral health benefits?

  • If yes, is procedural code (aka CPT code) 90837 {60-min psychotherapy session} with Modifier GT {therapy done online through telehealth} covered? 

  • If yes, is the telehealth standard for out-of-network behavioral health coverage, or just during Covid-19 response dates?

  • Do I have an out-of-network deductible?

  • If yes, is this deductible combined with my in-network deductible, or is it separate?

  • How much of this deductible has been met this year?

  • Do I have a co-insurance for out-of-network services once my deductible has been met?

  • Is any pre-approval required before obtaining out-of-network outpatient behavioral health services?  {This answer is almost always "no".}

  • Is there a maximum number of session I am covered for each year?  {This answer is almost always "no."}

  • What is the "allowed amount" for CPT code 90837 {or, in other words, how much of the $140 session fee will be reimbursed}?

  • My therapist will give me a "Superbill" receipt each month. What is the reimbursement process for out-of-network claims? 

To return to F.A.Q. page, click here.

WHAT YOU SHOULD KNOW ABOUT USING IN-NETWORK AND OUT-OF-NETWORK INSURANCE BENEFITS

Other than United Healthcare and HMSA, I am an out of network provider. That means that I am not participating on any insurance panel.

 

Upon request I will issue a statement of payment (along with an appropriate diagnosis) for anyone who wants to use their insurance to get reimbursement.

Although your insurance company may have mental health benefits there are a few things you should know regarding the use of those benefits:

  • If you use your mental health benefits your insurance company will require that the I give you a at least one psychiatric diagnosis which indicates a mental disorder. (Example - Major Depressive Disorder, Post-Traumatic Stress Disorder, (PTSD) Generalized Anxiety Disorder, Attention Deficit Hyperactivity Disorder (ADHD), etc) 

  • That diagnosis will remain in your medical record.

  • Should you decide to use your insurance I will provide you with a statement of services rendered.

HEALTH INSURANCE AND CONFIDENTIALITY OF RECORDS

If you use your insurance a disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims.

 

I have no control or knowledge over what insurance companies do with the information submitted or who will have access to this information.

You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy or to future capacity to obtain health or life insurance or even a job.

 

The risk stems from the fact that mental health information is likely to be entered into big insurance companies’ computers and then to be reported to the National Medical Data Bank.

Accessibility to companies’ computers or to the National Medical Data Bank database is always in question as life insurance and health insurance carriers will typically require a person seeking insurance to allow them access; an employer will typically require a job seeker to allow them access; and, in addition, computers are inherently vulnerable to break-in’s and unauthorized access.

 

In addition, medical and mental health data has been reported to be legally accessed by law enforcement and other agencies, which may also compromise your confidentiality.