Insurance Reimbursement

General Tips for Securing Reimbursement from your Insurance Company

  1.  It is your responsibility to know your coverage, deductibles, and copayments.
  2. Be familiar with the options available to you and your family. Policies can differ greatly from person to person even if underwritten by the same insurance company .
  3. Call the 1-800 number on the back of your insurance card to find out detailed information about your policy. Counseling is covered under behavioral health.
  4. Be sure to ask about information regarding your out of network coverage and how to submit for reimbursement. Many insurance companies have a coverage plan that allows you to go to anyone outside of your network providers. Many times it costs about the same or a few dollars more than your copayment.
  5. Ask for a ‘Single Care Agreement’ if you have no out of network coverage. Some insurance companies are willing to provide a one-time benefit to clients to prevent higher costs of inpatient or intensive outpatient fees.
  6. Always ask for a Supervisor in the Customer Service Department, as they usually have more authority to authorize treatment than a regular representative. Make sure you get their name, contact phone number and note the date you spoke to them. Ask them how to re-contact them if needed. This helps to keep them accountable for the information they relay to you.
  7. Remember! You and your employer pay a significant monthly premium to be insured, and you are their customer. They want to keep you satisfied. You have more control than you may think you have. Don’t give up.
  8. If all else fails, involve your human resource representative to get positive results with your insurance company. Your employer will want to update insurance contracts every year for new rates and benefits. Your employer can work with them at contract time to include benefits that are not covered. The best time to negotiate benefits and fees are when soliciting a new contact. Ask the HR department to negotiate to include specific services for the next contract year.
  9. MEDICARE: Perspective Counseling & Consulting, PLLC is not eligible to participate in Medicare as a contractor according to PMI 15.2.8. The patient is responsible for full session fee and to complete the following form and mail to Medicare. This document is from the website cms1490s-english-instructions-partb

**Note: Perspective Counseling & Consulting, PLLC is a in-network provider for BCBS, TRICARE and TRIWEST only. It is the client’s responsibility to pay full session fee for services rendered and to submit a superbill to other insurance companies for reimbursement**