Welcome to Omni Psychotherapy, LCSW, P.C. We understand that navigating the world of insurance can be confusing, so we’re here to help. Currently, we are in-network with Cigna, Anthem, and Empire Blue Cross Blue Shield (not the Empire Plan NYSHIP), Empire Blue Cross/Blue Shield Health Plus, Medicare and MagnaCare.
For our out-of-network clients, we are happy to provide monthly statements with all the necessary information for insurance reimbursement. It’s important to call your insurance company to find out exactly what mental health services are covered. Each plan has its own set of rules, limits, and procedures to follow. Some plans may require pre-authorization for services, while others may have a deductible that needs to be met before any reimbursements.
To help you understand your insurance benefits, we’ve compiled a list of helpful questions to ask your insurance company:
- Do I have outpatient mental health benefits?
- If yes, am I only covered for providers on the insurance company provider list, or am I also covered for out-of-network providers?
- What is my co-pay and/or co-insurance?
- Do I need to meet a deductible before receiving any reimbursements or paying any co-insurance or co-pays?
- If a deductible needs to be met, how much is the deductible, and how much of it have I already satisfied this year?
- With out-of-network benefits being used, what does the insurance company consider to be the usual and customary individual psychotherapy (code 90834) fee for a licensed clinical social worker in my geographical area, and what percentage of that fee does the insurance company cover?
- How many sessions per calendar year does my plan cover? Please note: The number of sessions per calendar year, even if unlimited, is not a guarantee that the company will ultimately approve and/or cover this number of sessions.
- Is there a maximum amount of charges allowed per year or in a lifetime?
- Do I need pre-authorization from the insurance company or a referral or approval from my primary care physician before my first appointment?
We hope this information is helpful in navigating your insurance benefits. If you have any questions or concerns, please feel free to contact us.
