Waterstone Counseling Center is in-network with Blue Cross Blue Shield*
If you have a Blue Cross Blue Shield policy and would like our support staff to verify your benefits prior to scheduling, simply complete the Insurance Verification Form to the right and our benefits specialist will get back with you. Please be aware that the verification of benefits doesn’t guarantee full payment on the part of your insurance provider. In this case, clients are responsible for making up the full cost of sessions.
*Excluding Federal BCBS, Anthem-Mercy EPO, Medicare, and Medicaid.
SINCE MENTAL HEALTH COVERAGE IS POLICY DEPENDENT, HERE ARE SOME QUESTIONS YOU CAN ASK YOUR INSURANCE PROVIDER TO LEARN MORE ABOUT YOUR SPECIFIC PLAN…
IN-NETWORK (BCBS)
Does my insurance plan include mental health benefits? (specifically CPT code 90834 & 90837)
What is my deductible? Have I met my deductible?
What is the coverage amount per therapy session?
How many sessions per calendar year does my plan cover?
Do I ned a referral from my primary care physician?
Is precertification or preauthorization required?
OUT-OF-NETWORK
What is my out-of-network deductible & co-insurance for a mental health office visit? (specifically CPT code 90834 & 90837)
Do I need a referral from my primary care physician?
Is precertification or preauthorization required?
How do I submit claims for reimbursement?
TELEHEALTH
Does my policy cover telehealth? (specifically CPT code 90834 & 90837)
If yes… Does that apply to any in-network provider or only with a specific vendor? (i.e. MDLive, Doctor On Demand, etc.)
Is the cost-share waived or am I still required to meet my deductible?
Is there a specific billing code that needs to be used? (i.e. modifier 95)
Call the Member Services number on the back of your insurance card to find out more details of your specific policy.
Insurance Verification Form
Common Insurance Terms
Effective Date.
The effective dates are the first and last day your policy is effective. Each year a policy may reset, which would include your deductible.
Deductible.
A deductible refers to the amount you will pay before your insurance provider begins to pay. After you meet your deductible, you will share the cost with your insurance provider by paying coinsurance.
Co-insurance.
Coinsurance is a percentage rate both you and your insurance company will pay after your deductible is met.
Copay.
A copay is a dollar amount you pay per date of service and the remaining amount for your session will be covered by your insurance company.
Out of Pocket Max.
The Out of Pocket Maximum is a preset dollar amount that you are responsible to pay. Once the amount has been met, you insurance should pay 100% for the remainder of the effective date.
PCP Referral.
Some insurance plans require you to get a referral from your PCP before accepting claims for mental health services. When that is the case, the referral needs to be sent to us before your 1st session or your claims will be denied.
Out of Network.
If we are Out of Network, it means we don’t have a contract with your insurance provider. If your plan has Out of Network benefits that you would like to utilize, you will pay for your sessions and then file a claim with your insurance.
Superbill.
A Superbill is a detailed invoice containing all the necessary information to file Out of Network claims.