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Using and Filing Insurance

For all PPO insurance plans except Aetna, I am an out of network provider. This means that you will pay me directly for services and submit paperwork to your insurance company to receive any reimbursement that they may provide. I will provide the necessary paperwork to do this, and your insurance will reimburse you directly.

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It is important that you get answers to the following questions from your insurance provider prior to our first session in order to fully understand what your costs will be.

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Prior to initial session, please call the number on the back of your insurance card and ask the following questions:

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  • Does my plan cover mental health services?

  • What is the rate of reimbursement for an out of network provider (i.e., what is the co-insurance rate)?

  • What is the amount of my out of network deductible?

  • How much remains to meet my deductible for the year? When does it reset?

  • Is pre-authorization needed for mental health services (specifically, for initial evaluation and individual therapy)?

  • Is there a yearly session limit?

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Using your PPO insurance benefits with me:

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  • Because I only accept Aetna insurance, I do not accept other insurance benefits directly, you will pay the full fee for each session at the time of service.

  • I will provide you with a statement covering the required information that you can submit to your insurance company (a "superbill"). They will then reimburse you directly.

  • You will receive an “Explanation of Benefits” (EOB) from your insurance company each time you submit a superbill.

  • If you remain in treatment until the time that your deductible resets (usually January 1 of each year), you will again need to satisfy your deductible in order to use your insurance benefits.

  • If you are billed for a missed session (session missed or cancelled within 24 hours of appointment), a claim will not be submitted to your insurance as insurance does not pay for missed sessions. You will be personally responsible for the full fee.

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This process has worked smoothly for many clients. Please contact me if you have any questions about this information. I am happy to help you get any reimbursement that is available to you.

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