You will need to find out if your insurance company “carves out” mental health to a subcontractor.  If so, you will probably need to contact the subcontractor, often a “behavioral health company.”

Ask if the following are covered by your insurance:

(biofeedback can include hand-warming, heart-rate variability biofeedback and neurofeedback…..make sure you ask carefully. Some insurance companies will pay for neurofeedback, but want it coded as psychotherapy. Others have a flat rate they pay for any biofeedback. Some do not cover any biofeedback in any form.

From the beginning, ask if it is possible to be covered for your treatment with the out-of-network psychiatrist AS IF SHE IS IN NETWORK (This is sometimes referred to as a “special exception” or “special accomodation”). What this usually involves is your request, and some lack of available in network providers suitable for you. If they agree, then they will contact the provider and attempt to work our a special case agreement with the provider, negotiate a fee, and make the authorizations necessary.

Depending on your situation, you may want to find out if your company covers group therapy and marital or family therapy

Also find out the following:

Ask how much they pay….whether your copay stays the same or increases over time. Here be shrewd and persistent. Some insurances refuse to tell you the dollar amount they pay until they know what the provider charges. Ask if they have a limiting charge, (on which they pay a percentage….then you pay the remaining percentage as well as the difference between the limiting chargeand the charge the provider charges.) Alternatively they may pay a percentage of the actual charge. If they insist on knowing what the provider charges, give them an estimate, such as 300 for an initial visit and 160 for follow up visits involving psychotherapy, and 100 for 25-minute medication checks. They

may also ask for the “CPT code”. In that case, be armed with the following codes:

90807 for individual visits for meds and therapy

90806 for individual visits for psychotherapy

90801 for initial psychiatric eval

90853 for group therapy

90862 for medication check

90847 for family therapy

Clarify the differences in your out of pocket expense if you see someone in network vs out of network. If the difference is significant, and you would like to see an out of network physician, you may have to be insistant.

How to do this? Say what you want and expect them to be able to provide to you as an insured member. For example, tell them you want to see a physician, and a woman (tell them you have your reason). Tell them you want to see someone who can see you weekly at least initially, that you want someone who is able to provide weekly psychotherapy, has openings, and is in a reasonable driving distance. Tell them you do not want split treatment.

If they give you a number of in network providers who they say can offer these things, check it out. Often they will say they have in-network psychiatrists, but when you call, you learn you will not see the psychiatrist except for the initial eval, (if that), and that the psychiatrist will not see you weekly for your therapy or even your med follow-up …. You will soon be seen every three months, while your therapy is relegated to someone else, often someone with less training in psychotherapy. In this case you will have to call back the company and tell them none of the providers are available. So you want them to authorize you to see the psychiatrist you have found, and to authorize it as a special exception, as if she is in network.

Some insurance companies offer this option, especially in physician shortage areas, which includes Accomack County.