Insurance Tips

All of the B2B providers are out-of-network providers and do not work directly with insurance companies. Some insurance companies will reimburse some of the cost for out-of-network visits; this varies based upon the individual insurance plan in which you or your family have enrolled.

GENERAL TIPS

  • Call your insurance ahead of time to learn about

    • rate of reimbursement for various services 

    • any rules for reimbursement

    • any deductible you might need to meet before receiving reimbursement

  • Submit monthly Superbills only

    • submit Superbills soon after receiving them. The sooner you submit them, the sooner you are able to identify if there are any issues that need to be addressed by yourself or your clinician in order to obtain reimbursement.

  • Do NOT submit Invoices, as invoices do not have sufficient information for reimbursement purposes

  • Coverage limits

    • Time billed for coordination of care between B2B providers and other outside providers (e.g., psychiatrists, pediatricians, PCPs, schools, psychological testing providers, and other medical specialists) is rarely reimbursed by insurance companies, and thus will be an out-of-pocket expense

    • Most plans will only reimburse for one service per day per patient (such as an individual therapy session and a couples/parent/family therapy session). If two services occur on the same day, one will likely be out-of-pocket. If you anticipate multiple services in one day, you are welcome to work with your provider to determine if one can be rescheduled.  

  • Health Savings Accounts (HSA) and Flexible Spending Account (FSA) cards can be used to pay for therapy sessions. You can upload these to the charting system.

  • If you have access to an Employee Assistance Program and it would be appropriate to utilize those services for your care, there are some cases in which we are able to work with the EAP to be a contracted provider. However, this is limited and not always possible, so please ask your provider about this directly.

SERVICE CODES

Typically, our appointments are set at 50 minutes, but some providers may spend a bit longer during a given appointment. The codes utilized are based upon the service provided and the time spent in that appointment. Common codes used for services provided include (but are not limited to):

  • Intake appointment: 90791 (typically 50 minutes)

  • Individual therapy: 90832 (16-37 min.), 90834 (38-52 min.), & 90837 (53-60 min.)

    • “Add on” code 95 for telehealth services

      • Telehealth services may be treated differently by your insurance plan, so you may want to contact your insurer to learn about your coverage for this care

  • Family therapy: 90846 & 90847

  • Group therapy: 90853 & 90849

  • Psychological (ADHD) Testing: 96130 & 96131, 96136 & 96137

  • Other: 90875, 90882, 90887

DIAGNOSIS

Reimbursement by insurance is often contingent upon a diagnosable condition being treated in the context of therapy. In most cases, it is likely that your provider will make an initial diagnosis after the intake appointment, which is informed by your self-report of mental health symptoms and the impact of these symptoms on your functioning. Please speak with your provider directly if you have questions or concerns about the diagnostic process and/or your specific diagnosis. Of note, if you do not qualify for a mental health diagnosis, you may still benefit from therapy services, although insurance will not likely cover the care you receive. 

MEDICARE

We have one clinician, Kaitlin Venema PhD, who is a Medicare provider. However, there are a limited number of cases they are able to take under this insurance. If you plan to seek reimbursement through your Medicare insurance, you will need to speak with these clinicians directly to know if they have space available.