Verifying Out-of-Network Benefits
J C Holistic Counseling
If you plan to use your insurance’s out-of-network benefits, we recommend following the steps below to help you understand your coverage and streamline reimbursement:
1. Call Your Insurance Provider
Please call the customer service number listed on the back of your insurance card. Have your card with you when you call. Select the option for “benefits” or “eligibility” and ask to speak with a live representative.
2. What to Say
Let them know you are seeking services with an out-of-network provider—a Licensed Independent Clinical Social Worker—for in-person and/or online psychotherapy. Be sure to clarify that you’re inquiring about outpatient mental health services, not medical or inpatient care.
3. Ask About Coverage for These Service Codes
If you have out-of-network benefits, ask whether the following CPT codes are covered:
- 90791 (initial diagnostic intake)
- 90834 (45-minute individual therapy)
- 90837 (60-minute individual therapy)
- 90847 (60-minute family or couples therapy with client present)
- 90846 (60-minute family or couples therapy without client present)
4. Take Notes During the Call
It’s helpful to write down the following information for your records:
- The phone number you called
- The name of the representative you spoke with
- The date, start time, and end time of the call
- Any reference or case numbers provided
5. Ask About Reimbursement Procedures
To ensure smooth reimbursement, ask your insurance provider:
- Do they require a specific claim form?
- Will they need a receipt or letter from J & C Holistic Counseling?
- What documentation is required from your provider?
- Where and how should documentation be submitted?
- What is the deadline for submitting a reimbursement request?
6. Clarify Upfront Payment
Let them know you will be paying your provider directly and that reimbursement will be issued to you, not to J & C Holistic Counseling.
If you have any questions after your call or need supporting documentation from us, don’t hesitate to reach out. We’re here to help!
