Insurance FAQ
- Blue Cross Blue Shield
- Blue Care Network (limited clinicians)
- ASR
- Priority Health (limited clinicians)
Table of Contents
Medical Billing FAQ: Costs, Codes, and Insurance Scenarios
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What CPT Service Codes do you use, I need them to verify my plan with my insurance company
Call the member service number located on the back of your card and tell them that you’re seeking behavioral health services and specify if it’s therapy or psychological testing. Below are the billable CPT service codes we use when billing for our services.
CPT Codes Used In Therapy: 90791, 90837, and Teletherapy
CPT Codes Used For Psychological Testing:
- Intake Appt #1: 90791
- Testing Appt #2: We bill a combination of the following – 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139
- Feedback Appt #3: 90837
What questions should I be asking my carrier? I'm completely new to this and it's overwhleming!
We completely understand, Insurance can be overwhelming! Not to worry you’ll only need to ask them 3 questions and please document the call with a reference number.
Main Questions To Ask Your Carrier When Conducting A Benefit Verification:
- Do I have a deductible that applies ? If so, how much and what dollar amount is currently met?
- Do I have a coinsurance portion that applies? If so, what is the coinsurance percentage?
- Am I missing any Coordination of Benefits information ? (If your insurance carrier is missing this information from you, they may deny all claims until you provide it to them. They simply need to know if you have another insurance policy that may cover your services. In this case, one policy will be considered primary and the other secondary. If we are out-of-network with your primary policy, you will need to pay out-of-pocket and submit a superbill invoice to them, which we can provide for you.)
What is the total cost of an assessment?
How does insurance work? I need to learn more about deductibles and other nuances.
This verification of coverage is NOT a guarantee of payment, and actual benefits can only be determined after YOUR carrier processes a claim. Benefits are subject to all contract limitations and exclusions. Be aware that occasionally the insurance representative may misquote benefit information to us. Therefore, it is always the client's responsibility to understand their insurance contract with their carrier.
While we do our best to facilitate payment between your carrier, we ask all our clients to make a personal financial commitment to cover any and all charges that may result from claim denial for your requested rendered services.
My insurance company told me the service is covered. Why do I have a balance?
In insurance terminology, “covered” means that the service codes are eligible for billing and are subject to your plan’s contractual limitations, which is ultimately the member’s responsibility to understand.
This means that “covered” does not necessarily equate to “paid.” If the services you are receiving apply towards your deductible, coinsurance, or copay, then your claim will be processed accordingly.
Example 1: If the total cost of your service is less than your remaining deductible amount and the deductible applies, you will owe this amount to the provider. The service is still considered covered and subject to the plan’s contracted rate. It’s important to note that insurance contracted rates are typically lower and discounted compared to private pay rates.
Example 2: Similarly, if your deductible has already been met or does not apply to the service, you may be responsible for a coinsurance percentage, a copay, or the insurance carrier may make a full payment based on the contracted rate. Whether the insurance company pays in full or shares the cost with you, the service is still considered “covered.”
In short, the word “covered” means “accepted and not denied or rejected.” If the service is not “covered,” the service costs will be subject to our out-of-pocket rates.
Thank you but I still have billing questions as they relate to psychological services!
We completely understand and would be happy to clarify! Feel free to email our billing department at billing@brightpinepsych.com
