F.A.Q. - Insurance Coverage
If you are worried about out of network coverage, please know that insurance does not have the final say in the care you deserve!
“Flex” Insurance Benefits
Most insurance companies have different pools of benefits. If you do not need therapy at a hospital (also known as inpatient) can request your insurance plan “flex” your inpatient benefit to pay for outpatient treatment. For example: You may have 30 days of unused inpatient benefits and no more outpatient benefits. It is possible that your insurance company will count each day of inpatient benefit as 3 days of outpatient treatment. PLEASE REMEMBER: All insurance companies are different. There is no standard. You must ask about each specific benefit
OUT OF NETWORK BENEFITS
Payment is made directly to BPLLC at the time of service. We process and send your out of network claims to your insurance on the 15th and 30th of each month.
Out of network benefits will cover a good portion of the cost of insurance up to 80% of the total session fee.
If you have any questions about using insurance at BPLLC please feel free to call or email us.
The Single Case Agreement
Many New Jersey Insurance Networks do not have specialists trained in modern and highly responsive therapeutic interventions. These include DBT, FBT, CBT and Eating Disorder care including management. Some insurance will allow coverage on a case-by-case basis. There is a good chance they will reimburse you at the “in-network rate” often called a “single case agreement.”
A formal request for using this benefit should be available from your insurance company. This requires you to determine that a fully trained Eating Disorder Specialist, certified by the governing board (IAEDP) is unavailable in your area. Please note that many clinicians who claim to be eating disorder specialists do not have the intensive training and certifications. They may employ mixed ideas and techniques, including some basic eating disorder knowledge. They lack the formality which is necessary for such a complex need. Most insurers do not verify credentials or specialties. They just check state licensure.
Questions you should ask your insurance company
- Does my plan cover psychotherapy sessions?
- Does my plan cover out of network services?
- Is there a deductible I have to meet?
- Do I have a copay?
- What is the coinsurance? How much of the does the coinsurance cover?
- Is there a maximum amount per session the insurance will cover for an out of network provider?
- How much time do I have to file a claim for out of network services?
- What is the process to get reimbursed for out of network services?
What are the fees?
Please contact me for further information and to schedule a discussion. As a specialist, I am in line with the current trends in cost throughout our tristate area.