Have your insurance card nearby. Speak to a customer service representative, as the automated benefits line does not always include Behavioral Health benefits.  

Verifying Benefits 

“I need my benefits for Outpatient Mental Health with in-network and out-of-network providers.” Please Note: Optimum Joy, P.C. is considered an Out of Network Provider of Mental Health Care. 

“What are my out-of-network mental health benefits?”

“What are my effective dates of coverage?”

“What is my annual deductible and how much has been met to date?”

“What are the different rates of reimbursement for the following CPT codes:”

90791: Psychiatric Diagnostic Evaluation

90837: Psychotherapy, 60 min

90834: Psychotherapy, 45 min

90847: Family psychotherapy, conjoint psychotherapy with patient present

“Where do we mail Behavioral Health claims?”

“Is precertification required?” If so, transfer to Authorizations Department and follow guidelines in the next section. 

Obtaining Authorization/Precertification 

Know your therapist’s name and credentials and mailing address.

“What is the authorization start date and end date?” (Be sure to disclose your first session date, if you know it, so it will be included in authorization.)

“How many sessions are authorized?”

“Where do we mail claims?” (IMPORTANT: This is often a different address than the one used in cases where precertification is NOT required).

We are committed to you & your family’s privacy, their confidentiality, and want you to have complete control over their health records. Submitting a mental health invoice for reimbursement carries a certain amount of risk to your confidentiality, privacy and future capacity to obtain health or life insurance or even a job. That is why we caution people to consider their risk to privacy prior to billing insurance for mental health services.

We are in-network with BCBS PPO, United Health Care, and Anthem BCBS insurance plans and our office bills these plans directly to the insurance. You would simply be responsible for any cost share amount or unpaid services. We provide a quote of benefits to clients so you can understand the cost of services and make a choice that fits your life. At times, the final claim processed by insurance quotes a different co-pay or financial responsibility of a client and the cost of finalized claims is the official cost of services regardless of the quote of benefits. However, majority of the time the quote of benefits matches your cost per session.

We can also provide you with receipts and a coded visit bill which you may submit to your insurance company for out-of-network reimbursement if you choose. We encourage you to check with your insurance regarding the specifics of your policy. If you want more information on this, don’t hesitate to contact our intake coordinator.

If you’d like to know your insurance coverage, call us today!

The use of insurance can be a helpful way to help cover the costs of therapy. In some situations insurance coverage might be the only way you or a member of your family can afford the care needed.

There are, however, some considerations you may want to keep in mind in deciding whether or not to use insurance. The most obvious concern is privacy, especially in situations where benefits may be administered through your employer’s human resource department or a managed care company. Many managed care programs require additional information beyond a diagnosis and sessions dates, such as treatment summaries and goal statements to determine eligibility for ongoing benefits. Optimum Joy is committed to preserving your privacy according to the Health Insurance Portability and Accountability Act (HIPAA) and to providing insurance companies only what is required to attain coverage. Unfortunately, we can not make assurances about what happens to information after it leaves our office. Further, use of insurance of any sort creates a record that might come into play later on when completing applications for life, health or disability insurance. People have been denied insurance and in some circumstances jobs because of a preexisting mental health diagnosis.

There are also situations where the insurance benefit for mental health may be quite limited or situations where a deductible may be quite large. In such situations you may need to weigh the expected benefit against the cost of sessions anticipated.

We can not advise you regarding your decision to use insurance but feel an informed decision is the best pathway to a good decision.