INFORMATION REGARDING INSURANCE ELIGIBILITY
Green Mountain at Fox Run’s program may be eligible for full or partial reimbursement from your employer-sponsored Flexible Spending Account or your personal Health Saving Account that is partnered with a high deductible health plan.
Both of these IRS approved plans (FSA and HAS) cover expenses for:
- Weight loss counseling with a detailed receipt and a Letter of Medical Necessity, signed by your doctor, to verify this expense is a medically-necessary treatment for a known medical condition.
- A weight loss program (for treatment of a medical condition) with a detailed receipt and Letter of Medical Necessity, signed by your doctor, to verify this expense is a medically-necessary treatment for a known medical condition.
Flexible Spending Accounts: FSA pre-tax funds can be used for you, your spouse, and your eligible dependents (as identified on your Federal tax return).
Health Savings Accounts: HSA funds can be used for you, your spouse, or eligible dependents (as identified on your Federal Tax return) even if they are not covered by the HAS-compatible health plan.
>This information should not be interpreted as tax advice from Green Mountain at Fox Run. Please seek the advice of your tax accountant and refer to this IRS Publication 502.
INFORMATION REGARDING OUR WOMEN’S CENTER ONLY INSURANCE ELIGIBILITY
Services through our Women’s Center for Binge and Emotional Eating are performed by licensed mental health counselors and registered dietitians, as such, many health plans will help you pay for these services. Because health insurance policies vary by company and policy, we cannot tell you specifically what your plan covers, but we encourage you to contact them directly for more information. We have listed below some key information to have available when talking with your insurance provider.
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. We will provide you with a superbill with all the information necessary for 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.