Important Information About Insurance & Billing
To ensure there are no surprises when it comes to billing, insurance coverage, and documentation—please read my guide below:
Non-insurance:
This is for those who choose to go out of pocket because I do not take your insurance plan, you do not have insurance, or you simply don't want to use your insurance benefits.
What to expect:
A Card is required to be held on file, and a superbill can be provided to you after each session or billing sequence.
This superbill can sometimes be used to file claims on your own with your insurance company to get reimbursement. If you have questions about this, please let me know.
I try to make Billing as comfortable as possible, so if needed, we can discuss how often this takes place or if payment needs to be split over time.
IF YOU ARE A CALIFORNIA RESIDENT, YOU ARE REQUIRED TO HAVE A DOCTOR REFERRAL EVEN IF YOU ARE NOT USING INSURANCE!
Insurance:
This is for those who are using insurance as part of their care and are considered in-network.
I am in-network with some of the major insurance plans such as:
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Blue Cross Blue Shield
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Aetna
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United Health Care/ UMR
Each insurance provider is different and each policy is different. So what is covered by some may not be covered by others.
Billing insurance companies is complicated, so, if you need support on how to talk with your insurance provider and what questions to ask, I can provide you with a detailed sheet with information to be filled out, which can guide the conversation.
Preventative Care vs. Medical Care
Preventative Care
Many preventative care policies have limitations on how many sessions and how long sessions are covered for, even if they fit within the qualifying diagnoses.
In order to be considered for preventative care, some insurance companies like United Health Care / UMR and Aetna require medical diagnoses from a physician in order to meet their strict qualifications. What is needed is the description of the diagnoses as well as the ICD10 codes. For example: E66.3 (Overweight), E66.9 (Obesity).
Preventative coverage can look like, but is not limited to:
UHC/UMR: Overweight, Obesity, Hyperlipidemia / Dyslipidemia, Hypertension (high blood pressure), Various forms of diabetes, Various forms of atherosclerosis, Family history of ischemic heart disease and other diseases of the circulatory system.
Typically allows for unlimited sessions as medically necessary.
Aetna:
Covers Obesity, Diabetes, High blood pressure, Pregnancy-related concerns.
Typically allows for 26 total sessions, with 10 sessions that can be for diabetes, high blood pressure, high cholesterol, and pregnancy-related concerns. The other 16 sessions–or a full total of 26–can be from Obesity management (BMI at/over 30).
Blue Cross Blue Shield (BCBS):
Variable by policy and state by state. Often allows for unlimited sessions as medically necessary without the need for a medical diagnosis from a physician.
Medical Care
This is basically anything that isn't preventative. Often meaning it comes with a Co-Pay, coinsurance, or deductible contributions.
What is needed:
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Verification of benefits: Now this may not be “Needed” for many policies, but I would highly recommend discussing this with your insurance company to see what is covered and by how much. Since coverage might be limited to the number of sessions, billing codes, or locked behind those doctors' diagnoses.
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For some insurance policies, a Doctor referral is required with states that they officially recommend you to see a specialist or receive specialized care. This can be done where your Doctor sends a Fax directly to me, or you can provide me with the document that was given to you.
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If you need assistance with this, I can do my best. Some doctors' offices DO NOT allow anyone other than the Patient to request this information, and many are slow to respond.
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Consent forms that allow me to bill your insurance company/ billing compliancy, communicate with your other medical team, and provide treatment
If the needed items are not completed:
For the policies that do not require a referral, typically the bill will be completed with the information I have accessible. Some sessions may be covered without any patient responsibility, and other times the session will require a co-pay, co-insurance, or will use your deductible.
Otherwise, the claim may simply be denied, and you will owe the cost of the claim that has been sent.