INFORMATION REGARDING INSURANCE ELIGIBILITY
Because our services are performed by licensed mental health counselors and registered dietitians, many health plans will help you pay for these services. Because health insurance policies vary by company and policy, we cannot tell you what your plan covers.
Please read your plan’s booklet under coverage for “outpatient psychotherapy” or “treatment of mental and nervous conditions” or in the case of dietary services “nutrition counseling.” You may also call customer service for the insurance company or your employer’s benefits office to find information specific to your questions.
HERE ARE SOME FACTS TO HELP YOU WHEN TALKING TO A REPRESENTATIVE:
- We are considered Out of Network Providers because we are not contracted with any insurance company as a network provider at this time.
- If you live outside of Vermont, you will also want to tell them that the services are provided Out of State.
- We are considered mental or behavioral health outpatient services offering specialized treatment for disordered eating.
- We bill CPT codes 90791, 90853, 90834. We will provide the diagnoses, which are primarily binge eating disorder, depression and anxiety.
- Nutrition services need to be billed through your medical policy and will be billed under a medical diagnosis needing clinical nutrition interventions.
You will pay for your services in full. If you provide us with the necessary information, including copies of your insurance cards, we will provide you with formal billing paperwork ready to mail to your insurance providers, and they will reimburse you based on your benefits. We cannot guarantee that you will be reimbursed for any services, but we can help you challenge any unwarranted denials by providing information on mental health parity laws in your state, facts about disordered eating and the need for specialized care, and provide case reviews if requested.
Remember that if asked, we will need to disclose diagnostic criteria and information from your medical record in order to seek reimbursement for services.
Thus far we have heard from our clients that they are receiving 70 – 100% of fee reimbursement using their out of network and flex and health savings accounts.