Out-of-Network Insurance

  • United Behavioral Health/United Healthcare/Optum
  • TriCare
  • Coventry
  • ValueOptions
  • Amerigroup
  • Medicare/Medicaid
  • Aetna

We are out-of-network with the above insurances. If you have Medicare/Medicaid as your primary insurance, and another insurance company as your secondary insurance, by law, we cannot submit claims for you.  You will be responsible for paying our fees up front, submitting your claims, and requesting reimbursement.

In these cases, your insurance may reimburse you for a percentage of fees if you have out-of-network coverage. If you decide to go this route, we will provide you with a statement suitable for submitting to your insurance company so that you may file claims on your own, with your insurance reimbursing you directly. Many patients are successful in seeking reimbursement for at least a portion of their assessment and therapy fees.  However, please remember that reimbursement is considered a matter between you and your insurance company. Always check with your insurance company directly for questions about your coverage and out-of-network benefits.

Your insurance may not cover mental health or may not have out-of-network benefits.

There are also times when in-network insurance policies do not cover mental health benefits.  If this is the case with your insurance, or your insurance does not cover out-of-network psychological services, then you are likely eligible to deduct the cost of services on your tax return as a health-related expense (please consult your accountant or tax return advisor for specific guidelines and information). You can also use money from a health savings account (HSA) or flexible spending account (FSA) to pay for services.  We are glad to work with you in terms of receipts or statements that you would need for your accountant or year-end planning.

To determine your out-of-network coverage, the first thing you should do is check with your insurance by calling the member services number on the back of your card.

You will need to ask the following questions:

  • Do I have “out-of-network” benefits for this provider?
  • Is there a deductible that must be met first, and if so, how much is that deductible?
  • What is my coverage for neuropsychological testing (codes 96136, 96137, 96132, and 96133)?
  • Is there a maximum unit number for those codes?
  • What is my coverage for therapy sessions (code 90837)?
  • Is there a limit to how many sessions I can have per year?
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