The most important thing to remember is we provide very high quality, competent, experienced services to our clients that saves time and energy in the short and long term.
We first want to tell you how we view insurance companies. We have to focus on helping with your life and insurance takes time and energy away from us helping. We know this because we have worked with insurance companies since the late 90s and it continues to create distractions away from other clinical support of our clients. We also understand that insurance companies can reduce out of pocket expenses, and clients have good reasons to have insurance and the support they provide. We want to help and are continuously working on increasing support with finances and insurance. Therapy of Hickory, Asheville and Spruce Pine is looking into how to take insurance and what insurance to take. We believe if consumers advocate for changes in mental health coverage, than the insurance companies will change. There are some health insurance companies that do better than others with supporting clients with mental health coverage.
It is possible, and our suggestion for clients, to look into different health insurance companies and shop for mental health converge. Look for coverage that provides in and out of network mental health coverage. This does take some time and energy as did the last time you shopped for health insurance. There usually is no penalty or negative consequence for shopping or switching health insurance companies, if you can find health insurance that better fits your needs.
Here is how you approach your health insurance company to explore out of network benefits, and you can use this information for shopping for health insurance that provides out of network mental health benefits.
First, find a contact/phone number for your health insurance provider to ask about your out of network benefits. The contact number for your company is usually on the back of your health insurance card, website, or bills.
Next, you will need to provide your full name, subscriber number, and your birth date. You may also need to provide our agency information, which is:
Therapy of Hickory
120 2nd Ave NE
Hickory, NC 28601
Also you will most likely be asked for our Providers National Provider Identification Number (NPI#).
David R Kadans NPI# 1669649950
Leigh B Kadans NPI# 1750576682
Next, call the customer service number and indicate you are the card holder and are asking about benefits and eligibility. Ask for a representative if prompted by voice system to reduce time waiting. Sometimes you can just hit the number 0 and it will fast track you to a representative. When you do get a representative tell them you are inquiring about your out of network mental health benefits. Tell them you are seeking services for a mental health outpatient agency and want to know how your policy helps with these services.
There are a few options your representative may discuss with you. The representative will state that yes you do have out of network mental health benefits or no you do not. If yes they will discuss or tell you how they work using words like copays or percentages, or deductibles.
Co-pays or percentages: Your coverage may reimburse you for all or part of your out of pocket payment for the mental health bill except a copay or portion you will have to pay, or the percentage of the allowable or usual/customary rate. This is the maximum amount the insurance company will allow/pay for this service. Ask for this on paper if it is confusing and our agency will work to help you understand and access reimbursement. There are different codes for different services that the insurance company will reimburse. These codes may need to be provided to ask about what your company will support you with.
The first three are the most used codes we use for individual and individual with significant other
90837-Individual therapy with or without family member present (45-55min)
90834-Play Therapy (45-55min)
90837-Extended Play Therapy (60min)
If you have out of network benefits, the representative will inform you of what deductible you must meet first before your benefits begin. The deductible is what you must pay first before health insurance company will begin to reimburse for services. Ask for the amount of the deductible and if you have already paid into the deductible. Also ask if this starts over each calendar year or if not when does it start over.
Finally ask what documentation is required to access reimbursement. We will provide you with all of our information including Therapist Name, NPI #, CPT Codes, Diagnosis Codes, address, dates, amount owed and paid. Usually documents to submit for reimbursement are located on the health insurance companies’ website.
If you have more questions please feel free to call us and we can continue to support you with your health insurance company. Thank you for working hard to access quality services that can help you heal, change, and grow.
For more information or to schedule an appointment in Hickory, Asheville, or Spruce Pine: