If Dr. Fazzari is not in-network* for your insurance plan, your treatment may still be covered.
Depending on your particular insurance plan and out-of-network provider benefits, you may be reimbursed for a portion of your therapy payments. If you have out-of-network benefits you would pay Dr. Fazzari the full fee at the time of the session, then submit that visit to your insurance company and have them reimburse you directly.
Reimbursement rates from insurance plans vary widely from the entire fee to a small portion of the fee. You can inquire about the reimbursement rate from your insurance carrier by asking what percent they reimburse (i.e., the coinsurance) for a 45-minute therapy session with a licensed psychologist and if there is any deductible.
Your insurance company may ask for a procedure code (a.k.a. CPT code). The code for an initial session is 90791 and the code for all following visits will be 90834.
The percentage they quote you may be based on the zip code you have your session in (10001 – for Dr. Fazzari’s office).
You should also ask what the “usual and customary rate” (UCR) is according to your insurance company as that is the rate upon which they will base their reimbursement. E.g., if they cover 80% up to a $100 per session UCR, anything over $100 would not be covered.
Other information you may want to ask your insurance company:
- Do I need preauthorization?
- How many visits are covered?
- How do I submit out-of-network claims?
- How long does it take for payment to be issued after you receive my claim?
Finally, your insurance provider will likely tell you that a quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service.
* An “in-network provider” is a clinician who has signed a contract with your insurance company agreeing to certain conditions and payments. An “out-of-network provider” is any clinician who has not signed a contract with your insurance company.