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How couples therapy is covered … and NOT covered

Couples therapy is often not covered by insurance policies as it is often deem it “elective”. When couples therapy is covered, we are often covered well by out of network plans, depending on the plan. Please know that insurance companies only cover ANY type of therapy for those diagnosed with a mental health condition. Therefore your therapist will be required to submit a mental health diagnostic code so it can be covered with a diagnostic code for coverage. Put simply, you or your partner will need to be diagnosed with a mental health condition for sessions to be covered by insurance. He highly encourage clients to do their research on how this diagnosis code could impact their coverage and/or them personally/professionally.

How we are covered … and NOT Covered

Wolfe Counseling is not in network with any insurance panels, however, your therapist may be covered, and covered well, as an “out of network” therapist. Known exceptions to this are Medicaid and Kaiser. Please be sure to follow the steps below to ensure the highest likelihood of out-of-network insurance reimbursement. It cannot be guaranteed that your insurance company will reimburse any part of your therapy expenses. It is your responsibility to ensure you know how your are covered by your insurance company.

Medicaid

If you are on Medicaid, legally you may only see an individual therapist that accepts medicaid. However, couples therapy is not covered by Medicaid and therefore we can serve couples who are on Medicaid. Be sure to let us know if you have Medicaid so we can be sure to serve you properly and legally. We offer scholarships to help with affordability if this is something you need. Contact us to find out more about our scholarship program and if we have current openings.

Call your Insurance Company Before Beginning Therapy!

Be sure to call your insurance company BEFORE BEGINNING THERAPY to understand how you are covered and what TYPES of sessions specifically are and are not covered. This will help your therapist provide therapy that has the highest likelihood of being covered. Diagnosis codes can sometimes be changed but CPT codes likely CANNOT be changed after the session is held as it may reflect insurance fraud. Here are a few questions to ask your insurance company BEFORE starting therapy:

  • Is couples therapy covered by my insurance plan? Couples therapy may not be covered as some insurance plans consider it to be “elective”.
  • What are my in-network vs out-of-network deductibles and copay/co-insurance rates? (Ask them to explain what these are if you do not understand your policy!)
  • Is my diagnosis code covered? Here are a few common diagnosis codes (your therapist may use a different code. Be sure to ask your therapist what you’re diagnosis code is):
  • Which of the following common CPT Codes are covered by my out-of-network policy?:
    • 90834 – Psychotherapy, 45-52 minutes with patient and/or family member (code for use of individual counseling only)
    • 90837 – Psychotherapy, 53+ minutes with patient and/or family member
    • 90834 + 90785 – Psychotherapy, 45-52 minutes + interactive complexity [additional time] add-on code
    • 90847 – Family Psychotherapy (included couples therapy)
    • 90846 – Family Psychotherapy (without the patient present)

Submitting for Reimbursement

Make sure you have the following information/documentation from your therapist before calling your insurance company:

  • ALL forms required by your insurance company (commonly available on your insurance company’s website). We usually require you to fill these out but are happy to help when needed. Contact us for assistance.
  • Diagnosis Code (listed on your Invoice and/or given to you by your therapist):
    • Dx Code
    • Dx Code Name
  • Invoice statement (provided by Wolfe Counseling administration. Contact us to receive an invoice. Please give 5 business days to process. Ensure that all the following information is listed on the statement:
    • NPI of the therapist
    • Tax ID for Wolfe Counseling
    • All dates of service should be labeled “PAID” (can also be listed as the “Form of Payment” being listed)
    • CPT Code should be listed for EVERY session

Good Faith Estimates

You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your medical care will cost Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a GFE for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your GFE, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. The therapists at Wolfe Counseling are independent contractors. As such, independent contractors are responsible for the care they provide, and are responsible for ensuring GFE requirements are met.

For Kristina's Clients Only

Billing statements can be printed on the client portal. See instructions below for finding the correct document on the client portal. Contact us any time with questions you may have or if you would like a statement to be emailed to you.

  • Current Invoices statement: Click on the Billing tab, select “Current Invoices” from the drop-down menu, then whether you would like to “save” or “print” your document. Ensure that all the following information is present on the statement:
    • NPI and Tax ID should be listed at the top
    • All dates of service should be labeled “PAID”
    • CPT Code should be listed for every session
  • Current Invoices statement: Click on the Billing tab, select “Current Invoices” from the drop-down menu, then whether you would like to “save” or “print” your document. Ensure that all the following information is present on the statement:
    • NPI and Tax ID should be listed at the top
    • All dates of service should be labeled “PAID”
    • CPT Code should be listed for every session
  • Other Helpful Documents on the client portal Billing page:
    Current Activity: Includes balance due, dates of service, and dates/amounts paid. (Good for HSA reimbursement or if CPT codes or other personal information is not needed)