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Eastside Insight
Eastside Insight
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    • Rose Gillis
    • Chanel Ryssel
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  • More
    • Home
    • About Us
      • Mission
      • About Therapy
      • Rose Gillis
      • Chanel Ryssel
    • Focus of Care
      • Areas of Practice
      • Our Services & Approach
      • Types of Therapy
    • Getting Started
      • Scheduling
      • Beginning Therapy
      • Financial Policy
      • Pay Model
      • Insurance Benefits
    • Fees
      • Discounts
      • Service Costs
      • Ancillary Costs
      • Appointment Policy
  • Home
  • About Us
    • Mission
    • About Therapy
    • Rose Gillis
    • Chanel Ryssel
  • Focus of Care
    • Areas of Practice
    • Our Services & Approach
    • Types of Therapy
  • Getting Started
    • Scheduling
    • Beginning Therapy
    • Financial Policy
    • Pay Model
    • Insurance Benefits
  • Fees
    • Discounts
    • Service Costs
    • Ancillary Costs
    • Appointment Policy

helping Clients Access Out-of-Network Insurance Benefits

Many sought-after Providers are moving away from deplorable insurance practices and becoming exclusively private pay and/or either working a hybrid model with only one or two provider friendly-insurance carriers (if you would like proof of this simply run a therapist search in the two most popular directories--Psychology Today and Good Therapy--and you will see this to be the case).  It means then if you would rather be selective and work with someone of your choosing, or someone who comes highly recommended with a strong reputation for providing quality care, chances are they are private pay, meaning then the most affordable way to accessing these providers is to use your out-of-network benefits.


Insurance though does not make this process easy, so please read through all of the guidance below prior to making your call to insurance.  Usually the best number to call is the one located at the back of your insurance card.


Out-of-Network Benefits: Does your insurance plan offer out-of-network benefits?


Reimbursement Rate: Fee-for-service reimbursement is often 80% for in-network, and 60% for out-of-network, but every plan is different, so please ask for the reimbursement rate specific to your plan. 

 

Deductible: Insurance commonly has a deductible that needs to be met prior to receiving reimbursement. If the deductible is large, or perhaps you have an HSA or FSA for such expenses, using your out-of-pocket benefits in this way makes a lot of sense. Knowing this information can help financially plan your care. 


Services: I have compiled a list of the most used and accepted CPT codes in psychotherapy (click tab below). CPT stands for Current Procedural Terminology. It is a medical code used in billing practices and by other accredited establishments to report the medical and diagnostic procedures and services of licensed healthcare professionals. Just because a CPT code exists though, does not mean your insurance will cover this service. When you review your benefits with your insurance agent, please also discuss these CPT codes to see which ones are covered, at what rate, as well as if there are any caps on number of visits or session lengths.   


Diagnosis: Insurance is based on medical necessity, so conditions that are less chronic or acute, or deemed as pre-existing, by your plan, may not be covered. It may behoove you to know what diagnoses are covered up front, or what is deemed as pre-existing. Some practitioners may opt to provide an alternative diagnosis that is covered, so that you can still receive services, but this constitutes insurance fraud and hides the extent of limitations in our healthcare system. 


Billing

I use behavioral health software that allows me to both create and electronically submit what is known as a ‘superbill’ on your behalf to insurance, saving you the step of filling out the insurance claim forms and mailing them in. Payments also tend to be processed faster, like 1-2 weeks, when submitted through a provider. A superbill lists the CPT codes associated with the services rendered, diagnosis, place of where you received care, as well as the practitioner’s licensing information. Given that I am not charging your insurance, it means I do not have to provide progress notes about what took place in therapy, and in most cases, the criteria for diagnosis. The reimbursement check will be sent directly to you. Moreover, I will not be notified of any denials to your claim if they occur, as I am not charging your insurance, but rather submitting a bill for you. You will need to follow up with your insurance directly if problems arise. 

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Open: Monday to Friday (By Appointment)

In-Person Practice Location: 310 3rd Ave NE, Ste. 116, Issaquah, WA 98027 / Business Address: 1400 112th Ave SE, Ste 100, Bellevue, WA 98004

P: 425-245-5981 / F: 425-225-7487

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