Resources
Getting reimbursed for therapy
How to talk to my health insurance company about reimbursement?
Thank you for choosing Embracing Self Counseling & Consultation LLC as part of your mental health support community. As we are a out-of-network practice, we wanted to provide you some information on the process of getting reimbursed from your health insurance company for therapy if you have out-of-network benefits.
A few terms for those new to insurance:
1. Out of network: The provider does not have a contractual agreement with the insurance provider to accept a specific reimbursement rate from them.
2. Co-pay: A fixed out-of-pocket amount paid by you for covered services.
3. Co-insurance: A percentage of costs of a covered service you pay. This is typically applied after you've paid your deductible.
4. Deductible: The amount you must pay first before your insurance plan begins to cover services you are seeking. There may have a separate deductible specific for in network and out of network services.
5. Out of pocket costs: The costs you are expected to pay after the insurance company reimburses for their portion of the costs.
6. CPT code: A code used to help identify what type of service is being provided by your health provider.
7. Expected charge/ Usual and Customary charge/Contracted rate: This is the rate that each individual insurance company has negotiated with in network providers for the various services they offer.
Calling to get more specific information on your expected out of pocket costs:
We recommend you call your health insurance to get some additional information so that you can figure out what your estimate out of pocket costs will likely be for the course of your treatment. Here are some questions you can ask your insurance.
Information to have one hand before your call:
Your information:
1. Name and date of birth
2. Primary subscriber name and date of birth
3. Health insurance card with the following info:
a. Insurance ID number
b. Group number
c. Primary subscriber employer if this is an employer paid insurance plan
Your therapist’s information:
1. CPT code for the service you are being provided. Here are a few common ones
a. 90791 : The initial appointment or intake appointment
b. 90837 : A standard therapy session (45 min)
c. 90834: A shorter therapy session (30 min)
d. If you don’t have the one you need, please call Dr. Lee to ask for this information.
2. Office location: Zip code is 19809
Questions to ask customer service representative
1. I’m seeking outpatient mental health/behavioral health benefits. Does my plan cover out of network providers for this service?
2. If yes, what is my coverage?
3. What is my out of network deductible? And how much of that is met so far?
4. My therapist charges $XX for CPT code ____ for zip code _____. How much of the $XX will be reimbursable?
5. Is there a limit to the number of sessions per year for my plan?
6. Can you take me through the process of submitting superbills for reimbursement? Is there a time frame in which this documentation needs to be submitted? Is there a specific form I need to fill out, and if so where can I find this form? Is this something you can send to me over email?
7. What is the time frame I can expect to be reimbursed after submitting the documentation needed?
Asian American Mental Health Resources
Here are a few resources for Asian/Asian American who are interested in learning more about therapy or wanting additional resources focused on mental health of Asian Americans. Below is not an endorsement of any of the authors or webpages, but a complication of well-known resources. Our hope is through providing these resources we help move to destigmatize mental health issues and increase access to therapy and mental health resources to our fellow Asian/ Asian Americans.
Asian American Self Help Books:
Permission to Come Home: Reclaiming Mental Health as Asian Americans by Dr. Jenny Wang
Breaking the Bamboo Ceiling: Career Strategies for Asians by Jane Hyun
Asian American Mental Health On-line Resources:
Asian Mental & Emotional Health Podcast Lists
South Asian Sexual & Mental Health Alliance
Crisis Line for East Asian Language Users:
Asian Lifenet Hotline (Cantonese, Mandarin, Japanese, Korean, Fujianese translators available 24 hrs) based out of NYC: 1-877-990-8585
Directory for Asian American Mental Health Providers:
Asian American Psychological Association Directory
Asian American Health Initiative
Asian Mental Health Collective
Philadelphia Asian Mental Health Providers and Resources
National Asian American Pacific Islander Mental Health Association