In Network Insurance Policy
Understanding the needs of many people in the Flathead Valley, I’m happy to be in-network with a few insurance companies and more to come. Currently, Gable Counseling is considered an in-network provider for:
Blue Cross and Blue Shield
If you are not covered by the above insurance providers please check out the link below to understand other options, like out-of-network reimbursement.
With any questions please call me at 406-396-0266
Getting Fair and Accurate Insurance Reimbursement for Your Psychotherapy
The process of getting reimbursed by insurance is much easier than it initially sounds.
Here is your guide to make sure that your insurance company is handling your reimbursement fairly and correctly.
1. Call your insurance company to find out your coverage
You’ll need to call your insurer, specifically for “mental health” services (often handled by a different department than medical claims, or sometimes by a different company).
When you call your insurer, they’ll let you know what your policy covers in general terms — for example, 80% of the “customary and reasonable” fee (this might also be called “usual, customary, and reasonable”, or UCR, the term I’ll use here).
So, for example, if your insurer only considers $90 to be the UCR for individual psychotherapy, they’ll pay 80% of that, or $72. (After you’ve met your deductible, that is.)
2. Get your insurer to tell you how they calculate your reimbursement
Unfortunately, insurance companies usually won’t divulge what they consider to be usual, customary, and reasonable. Often, they’ll say that it is “proprietary information.”
What you can do to work around this is to tell them the fee that the provider charges for a particular service, in a particular geographic area or zip code — and to be educated about the prevailing fees in your area.
So if you call about what to expect for reimbursement for my services, that would be:
• You’ll be submitting claims for “Individual Psychotherapy, Outpatient, 45 minutes,” also referred to as CPT code 90834.
• My current fee for CPT code 90834 is $120.
• My Zip code is 59937 (reimbursement varies based on location).
• I’m a licensed psychologist, and I am a non-participating provider (meaning that I have chosen not to have a “contract” with any insurance companies).
Then ask them if my fee is above their UCR — what they’re willing to pay for that service. When you ask them, if they say anything, they’ll typically only say “yes” or “no” — so you won’t know if the fee is only $5 more, or $100 more than what they claim is reasonable and customary.
3. Know the rules and be an informed consumer
Unlike most aspects of health insurance, there are very few regulations for insurance companies when determining what they consider reasonable or customary. In fact, only a few states even define what constitutes the terms “reasonable, usual and customary” and even fewer have regulations on the methodology used in determining these charges.
There’ve been some changes about this (after many class action lawsuits, and work on healthcare laws). You can go to a consumer rights site and see what an objective source says the customary rates are in a particular geographic area (therapy costs more in DC than in, say, Iowa).
The site is Fair Health Consumer. Click 'Search for Medical Costs'. Type in “59937” for the zip code, and “90834” for the CPT code (that’s the code for individual outpatient psychotherapy, 45 minutes).