Insurance Filing

There are many an app that helps patients who pay out-of-pocket to get reimbursed by their health insurance, at whatever rate is covered by your plan.

IF your plan does not have a high enough coverage, you can petition your company for a SINGLE CASE AGREEMENT. This means that we will be treated as an in-network provider for you, and that our services will be covered as if we were an in-network provider.

Factors that substantiate Atlanta DBT obtaining an SCA:

we are intensively trained, and run a full protocol clinic
the adolescent/family program is full protocol like Miller's research dictates.
we offer full RO-DBT, the highest efficacy treatment for anxiety, depression, trauma, PTSD, anorexia, and spectrum disorders.
we offer RO-DBT for adolescents!
we are intensively trained in STAGE II DBT.
we are the only ones to offer STAGES III & IV DBT worldwide.

**Atlanta DBT does not endorse any particular agency.

Tips on working with your insurance company:

You can significantly increase the likelihood that your insurance carrier will cover therapy. The following considerations usually indicate the need for your company to agree to a single case agreement whereupon an out of network provider is considered in-network for you. Here are the 3 greatest factors (but not limited to) in determining coverage:

If you are a high utilizer of behavioral healthcare services.
1. If you have had a hospitalization
2. if you are suicidal
3. if you have been suicidal recently
4. you are self harming (raging, cutting, drinking, purging, restricting--any behavior that harms your health or puts you at risk)
if you live run by outside a specified radius from a true protocol program with Intensively Trained Practitioners
if you require treatment for depression, anxiety, OCD, PTSD, anorexia or spectrum disorders--and you need DBT, then we are the ONLY program in GA that has an RO-DBT PROGRAM that meets this requirement specific for these illnesses. Insurance companies generally agree to out of network services if they cannot provide the service in network, or if the distance is too great to travel elsewhere.

CPT CODES that your company will ask for:

90791: Initial Evaluation

90837: Individual Psychotherapy, 60 minutes

90853: Group Therapy (skills classes are coded as such, even though they last 2 full hours.)

Insurance FAQ:

Most companies provide “out-of-network” benefits for non-participating providers. This means you will pay the agreed upon fee at the time of service and you will be provided with the documentation required by most insurance companies for reimbursement.

It is highly recommended that you contact your insurance company prior to scheduling an appointment to determine how much you will be reimbursed. Please check with your insurance company and ask the following questions:

Call the Member Services phone number on your insurance card.
If your insurance company has a separate phone number for Mental Health or Behavioral Health, call that instead.
Ask to speak with a customer service representative.
Request information for Outpatient Mental Health benefits.
Have the customer service representative explain your “In-Network” and your “Out-of-Network” benefits. Atlanta DBT is an out-of- network provider.

What is an out-of-network claim?

An out-of-network claim is a request for your health insurance company to reimburse a bill from a provider that does not have a negotiated contract with your health insurance company. If you are billed for the full cost of a visit directly by your provider, or they have told you they do not accept insurance, it is likely they are out-of-network.

Do all health insurance policies reimburse out-of-network claims?

No, not all policies reimburse out-of-network claims. Check with your insurance provider to see if your plan has out-of-network benefits. Typically, a PPO or a POS type plan will have some type of out-of-network coverage, while most HMO and EMO plans only reimburse for out-of-network care in the case of an emergency.

What is an in-network claim?

An in-network claim is usually filed directly by your provider with your insurance company. An in-network provider has a contract already in place with your health insurance company. For an in-network visit, you are only responsible for paying the copayment or for the portion of care not covered by your insurance.

What data should be on my bill?

To process your claim your bill will need to include your name, your provider’s name, your provider’s employment identification number (EIN or TIN) or social security number, your provider’s National Provider Identifier number, the code(s) for your diagnosis, the code(s) for any procedures, the date of your appointment (date of service), and the total amount of the bill. A bill with all this information is called a “superbill.”

A reimbursable superbill includes:

Provider’s name
Provider’s address
Provider’s phone number
Provider’s tax ID (EIN number)
Date-of-service
Amount charged
CPT code (procedure code)
ICD -10 code (diagnosis code)

Questions to ask your insurance company:

Deductibles: How much will you have to pay before the insurance company will begin paying? After the deductible is met for testing/therapy sessions, at what percentage will they cover the remainder of the services?
Fee caps: Some companies will only pay out up to a certain dollar amount regardless of the fee charged by the psychologist.
Session limits: How many sessions are covered per calendar year?
Diagnoses covered: Are there particular diagnoses that are not covered?
Claims address: What is the mailing address where claims must be sent in order to get reimbursement?
Preauthorization requirements: Is preauthorization is required for outpatient mental health? If yes, what is the process is for obtaining this? Also, are treatment plans necessary for continued treatment?
Providers: Is it possible to meet with a provider that I choose and submit receipts for reimbursement?
Forms: What forms are required for filing? Where can I get those forms?
Telehealth: Do my benefits cover telehealth services (online counseling)?