Out-of-Network Insurance Help Document

 

Journeys Counseling Center is a fee-for-service practice where payment is due in full at the time of your session.

The therapists at Journeys Counseling Center do not accept AHCCCS, Medicare, or Medicaid and they are not contracted with any insurance providers.  However, our therapists are considered “out-of-network providers” so, if you have out-of-network benefits, you may receive some reimbursement for our services if you submit claims directly with your insurance company.

The amount that insurance companies reimburse for “out-of-network” services varies by plan. We recommend calling your insurance company before your first appointment and discussing your benefits.

Here is a list of questions that may be helpful to ask your insurance company: 

  1. Are there out-of-network behavioral health benefits for this policy?

  2. Is prior authorization required?

  3. Do I have an out-of-network deductible?

    • If yes, you may want to ask:

      1.     1. How much is the out-of-network deductible? 

      2.     2. What is the start date of the calendar year my out-of-network policy is based on? 

  4. Does the policy cover the CPT code listed below? These are codes frequently used at Journeys Counseling Center.

    Type of Service // Service (or CPT) Code

    • Initial Evaluation/Psychotherapy // 90791

    • Individual Psychotherapy // 90834

    • Family or Couples Psychotherapy // 90847

    • Group Psychotherapy // 90853

Here are some helpful tips to note when speaking with the insurance representative:

  • Not all services provided in our office will be covered and each type of service will be reimbursed at a different rate.  It is helpful to know what type of service you plan on receiving in our office.

  • Insurance companies have a set allowable amount for each service type and reimburse a percentage of that amount. The allowable amount may differ from the therapist’s fee. 

  • With many out-of-network benefits, a deductible has to be met before any reimbursement is acquired.  It’s important to know what your deductible is so you can budget accordingly.

  •  In most cases, it is possible to submit for reimbursement by mail using the mailing address on the back of your insurance card. Additionally, it may also be possible to submit electronically - check with your insurance provider about their preferred process.

 

At your request, we will mail, email, or fax your statements-of-service to you. It is your responsibility to submit these claims in a timely manner as most companies have a 30-180 day filing policy. We recommend that you regularly monitor your Explanation of Benefits (EOBs) to ensure prompt and accurate processing of any claims you submit.

 

* Please note that Journeys Counseling Center is not responsible for reimbursement that is denied for any reason.

 

We understand that working with insurance providers can be difficult and we are happy to answer any questions you may have about the process. Please contact our administrative staff at 480-656-0500 ext 3 or at contact.journeys@gmail.com with any questions or concerns.