Insurance Coverage/ Employee Assistance Programs (EAP)

 

Verification of benefit coverage is not a guarantee of claim payment.

All benefits are subject to the terms and conditions (e.g. authorizations, network requirements) outlined in your member contract with your insurance company. We have no authority to make representations to you regarding coverage of items or services covered.

 

New clients need to know a few things before beginning counseling.

* We do not participate in any other medicaid or any medicare programs.*

Paperwork and telephone calls are a necessary part of the preparation.

The client must call their insurance company prior to the first appointment   (see “How To Check Your Benefits”).

Not only will this telephone call inform the client financial responsibility but it is also becoming a requirement per the insurance companies.

 

 

Note: Most Insurance Companies and Employee Assistance Programs are requiring that Pre- authorizations be obtained before seeing a counselor. Otherwise, the insurance company or EAP may refuse to pay for services.  Therefore,  you will be financially responsible for payment. 

 

 

How To Check Your Benefits:

 

Call your insurance company or EAP using the 1-800 number listed on the back of your insurance card. Let the representative know you are inquiring about “outpatient mental health benefits” or “Company provided EAP sessions”.   It is not uncommon for health insurance companies to have a separate department, division, or company for mental health (a.k.a. behavioral health or psychotherapy) coverage versus medical health coverage.  Please so be sure to ask them about Outpatient Mental Health in an office setting benefits.

 

     Verification of your benefits.

 

     It is important to ask about the following information:

• Pre-Authorization: If an authorization number is required for any visit.

• The co-pay amount.

• The number of visits allowed.

• The date range the visits are authorized (i.e. between today’s date and three months from now).

• Authorization number for EAP sessions, and if you should call them back after setting an appointment.

• The deductible.

 

     Being able to know up front your estimated costs you will spend helps you: 

• Achieve a better handle on your health-related finances.

• Eliminate surprises when you get your EOB from your insurance company.

• To be a more informed consumer.