How Do I Pay For Services Using My Health Insurance?

We Recommend That You Contact Your Health Insurance Provider Before Treatment

Some important questions to ask include:

• What are my mental health insurance benefits?
• Is preauthorization required before I make an appointment? If so, you may have to call your Primary Care Doctor and get the preauthorization before treatment for it to be covered.
• Is the therapist that I want to see on your preferred provider, in-network provider  list?
• If not, what is my coverage for out-of-network providers? Note that almost all health insurance plans require the patient to pay more for an out-of-network service.
• What is my deductible for both in-network and out-of-network therapists and has the deductible been met for the year? (Your deductible is the amount you need to pay out of pocket before the insurance plan starts paying). With many health insurance plans, a patient pays 100 percent of costs out-of-pocket until they have met their deductible.
• How many sessions per year does my health insurance cover with this therapist?
• What is my co-pay? How much will I be responsible to pay at each therapy session (your copayment).
• What is my coinsurance amount? Coinsurance is the amount you pay for covered health care after you meet your deductible. After meeting the deductible, a patient pays a defined percentage – the coinsurance amount. For example, a very common coinsurance arrangement is that the medical insurance company pays 80 percent of costs for a given therapy, with the patient paying 20 percent.

Even though I am on many Insurance lists, each insurance company has different plans. For example, I am on Blue Cross HMO provider list but not on Blue Cross Anthem provider list.  You will need to check if I am on your insurance companies In-Network Provider list.

You will need to give them my name, Wayne Kessler, our NPI number which is: Group NPI# 1366145393. If they ask, our Tax ID# is: 92-3049557.    My individual  NPI# is 1114173010.

Health Insurance Plans I Do Not Accept

I do not accept any of the MA state health insurance plans, including Medicare, Medicaid, MassHealth, or MassHealth Connector plans such as Tufts Direct, Tufts Together, or Tufts Spirit. Also, I do not accept many EAP plans. Again, call the number on the back of your card and check if I am in-network or if you have out-of-network benefits and can get back some of the cost of therapy.

Health insurance can be tricky so it pays to call your insurance company before seeking treatment to see if your provider is “in network.” In-network means that they are on an approved clinician list and have prearranged a (usually reduced) cost for the psychotherapy services.

This is important to check because if the provider is not on the “In Network’ list you may have to pay out of pocket for services. Sometimes, my clients decide to do private pay, and some insurance plans will reimburse you for a percentage of “Out of network” costs, but many do not. So it is important for you to check, even if your provider tells you they are credentialed with the specific insurance company.

Important Terms Used in Insurance Coverage

When it comes to health insurance, there are a few key terms you should know: co-pay, deductible, out-of-pocket maximum, and co-insurance.

Co-pay:  A co-pay is a fixed amount you pay for a specific medical service or prescription.

Deductible: Is the amount you pay each year for most eligible medical services or medications before your health plan begins to share in the cost of covered services.

Co-insurance: Is the percentage of costs you pay for covered services after you’ve met your deductible.

An out-of-pocket maximum: Is the most you’ll pay for covered services in a plan year. Once you reach this amount, your insurance will cover the rest of your eligible costs.

In-Network provider:  Means that the clinician has been approved by the health care company to offer services at a specific negotiated (discounted) rate.

Understanding these terms can help you make informed decisions about your healthcare. If you have any questions, call the phone number on the back of your insurance card for more details. Once you have verified all your benefits, confirmed I am listed as an in-network provider, and obtained any needed preauthorizations,  contact me to book a session.