Insurance and Out-of-Network

​At Specialized Psychology Services, I am sometimes an “out-of-network” provider. Please contact your insurance company to determine your out-of-network mental health benefits.

Some may choose to pay out of pocket to maintain privacy, and others may desire to use their insurance plans. If you decide to seek insurance reimbursement, a monthly itemized statement, or “Superbill,” will be made available to you via the client portal (I also offer Mentaya, which helps submit weekly claims for reimbursement. Check your benefits here: https://app.mentaya.com/p/DQZCYQRXxgu8SlJd4p9D.

Use of a Health Savings Account (HSA)/Flex Spending Accounts (FSA) is another way to reduce the cost of therapy.

I am currently accepting the following insurances:

Insurance

• Aetna

• Optum

• Oxford

• UnitedHealthcare UHC | UBH

• Out of Network

Details:

·         Oxford Health Plans

·         Aetna

·         UMR

·         Oscar

·         UHC Student Resources

·         AllSavers UHC

·         Harvard Pilgrim

·         Meritain

·         Nippon

·         United Healthcare Shared Services

·         Allied Benefit Systems – Aetna

·         Surest (Formerly Bind)

·         Health Plans Inc.

·         UnitedHealthcare Global Optum Live & Work Well (EAP)

·         Christian Brothers Services – Aetna

·         Trustmark Health Benefits – Aetna

·         Trustmark Small Business Benefits – Aetna

·         Health Scope - Aetna

Verifying Your Benefits

To find out what your insurance plan will reimburse you for, call them and ask the following questions:

•  Do I have mental health benefits?

• Does my plan have out-of-network benefits?

• What does the company allow (“reasonable and customary”) for the following psychotherapy codes: 90837, 90834, 90832, 90847, and 90791?

• How much does my plan cover for an out-of-network mental health provider?

• Are there standardized forms I will need to submit for reimbursement? Where do I find them?

• How many sessions per calendar year does my plan cover?

• Do I need to be pre-authorized or referred first?

• Are telehealth sessions covered? 

 ** This brochure can be printed to take notes when you call your insurance company.

Further Information

 See these articles for further information about Out-of-Network:

• https://blog.zencare.co/reasons-to-see-out-of-network-therapist/

• https://blog.zencare.co/guide-to-out-of-network-benefits/

• Please direct any questions/concerns to info@drjuliekahler.com to discuss further.

Good Faith Estimate

 If you are not using insurance, the “No Surprises Act” gives you rights so that you are aware of the cost of healthcare with a “Good Faith Estimate” for the expected cost of any non-emergency services. You may request an estimate of any health care provider prior to scheduling a service. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. My fees are listed below, to ensure I clearly communicate cost verbally and in writing. In the event of special circumstances or need for additional services, there could be additional fees, which you will be informed of, as soon as possible, so you can make informed care decisions. If you are billed a sum that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. See here for further information. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

  *****Reminder: Clients are responsible for paying the full fee at the start of each session. Then, if you choose to use Out-of-Network, you will submit monthly bills to your insurance company for reimbursement. Make sure you call your insurance company to verify first.

*******Note: “No Surprises Act” (Section 2799B-6 of the Public Health Service Act) is currently under interpretation since it went into effect January 1, 2022. The “Good Faith Estimate” information above is intended to provide information solely, to inform consumers.