Questions to ask your insurance carrier if you want to use out-of-network benefits  

Do I have out-of-network mental health benefits?

Do I have an annual deductible and how much has been met?

Once my deductible has been met, at what percentage do you reimburse for these services (ie, what’s my co-insurance)? Is this based on the “allowed amount” or the provider’s full fee?

If the former, what are the allowed rates for cpt codes: 90791, 90837, 90834 and 90853?

Is there an out-of-pocket limit, beyond which my insurance covers 100% of the allowed amount or full fee?

What is the process of seeking reimbursement?

What forms do I need to submit, where do I get them, and what information do I need to include in order to be reimbursed?

Use the following info for this practice when checking benefits:

ELIZABETH BARCH NPI1: 1679914147

AMETHYST INTEGRATION NPI2: 1326807249

Figuring out your out-of-pocket cost when using 0ut-of-network benefits for KAP packages

Call your insurance carrier and ask for the customary reimbursement rates for the following CPT codes:

90791

90837

Then plug in the customary reimbursement rates they provide into the following formulas to find how much you will be paying out-of-pocket:

3 KAP Session Package

$3075 - (90791 x2) - (90837 X6)= out-of-pocket expense

5 KAP Session Package

$4475 - (90791 x2) - (90837 X10)= out-of-pocket expense

Add on 50 minute session

$200 - 90837= out-of-pocket expense

1 KAP session plus integration session

$825 - (90837 x2) = out-of-pocket expense

For help, feel free to contact us once you’ve received the above CPT code reimbursement rates from your insurance carrier. We are more than happy to help you determine your financial responsibility when using out-of-network benefits.