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Insurance Information:
 

Insurance
Obtaining authorizations and filing insurance claims consumes much of our staff time and is a courtesy to the client.  We accept several insurances and we will be happy to file claims‛ for those listed below.  If claims are denied, we will re-file one time.  If claims continue to be denied, the client is responsible for payment.  All deductibles, co-pays, and co-insurance payments are due on the date of service.  If these are unknown until filing occurs, the staff will estimate these costs based on your responsibility for the % rate of the UCR (Usual Customary Rate, provided by your insurance company). 

Some questions you need to ask your insurance company:

  • Do I have mental health benefits?
  • What is my deductible and has it been met?
  • How many sessions per calendar year does my plan cover?
  • How much does my plan cover for an out-of-network provider?
  • What is the coverage amount per therapy session?
  • Is approval required from my primary care physician?

If your insurance accepts out-of-network providers, you will be required to pay for services in full on the date services are provided and we will give you the proper paperwork‛ to file your own insurance claims so that you can be reimbursed directly from your insurance carrier.  If we are not on your panel and you cannot access out-of-network providers, you will be required to pay for services as they are rendered.

Insurances we accept:

  • Blue Cross Blue Shield (Board of Regents, Federal Plan, Indemnity, PPO)
  • Blue Cross Blue Shield / Anthem
  • Blue Cross Blue Shield / Magellan Behavioral Health
  • Blue Cross Blue Shield / ValueOptions
  • ChampVA
  • Companion Health Insurance
  • Georgia Medicaid (Disability)
  • Georgia Medicaid HMO (Amerigroup, fostercare)
  • Golden Rule
  • Tricare / Value Options
  • United Behavioral Health
  • United Healthcare

Unfortunately, we cannot accept or are not on the boards for the following insurances at this time:

  • Aetna
  • Blue Cross Blue Shield POS or HMO
  • Cigna
  • EAP plans (Employee Assistance Plans, any insurance)
  • Georgia Medicaid HMOs (PeachCare, Wellcare, or Cenpatico)
  • Medicare
  • South Carolina Medicaid

If you have one of the plans on the latter list, you may chose to pay privately for services.

Be aware that Court Ordered/Mandated evaluations are not covered by any insurance.  Court Ordered therapy is not always covered by insurance.  Legal work is $300.00 per hour including office visits, testing time, scoring, report writing, record review, travel to and from court, testifying, and phone calls.  If you are court-ordered to attend therapy and therapy is covered by insurance, all outside time spent on your case will incur the usual legal fee.

Administrative & Professional tasks such as phone calls, OHI/special edcuation paperwork for school, additional letters/faxes and preparing Superbills are subject to additional fees.

Since plans and participation constantly change, please call your insurance plan to determine if we are currently covered by your insurance plan.

  1. Most insurance companies will not pay for academic testing.  This service will not be filed to your insurance company or remitted on a HCFA form for you to file.  We will not provide a CPT code for these services.  You will not see this portion of  services on your insurance EOB (Explanation of Benefits).  This amount is the responsibility of the client.  Pricing is available in the office.

  2. Some insurance companies will not pay for portions of cognitive (IQ) and/or neuropsychological testing.  These services will not be filed to your insurance company or remitted on a HCFA form for you to file.  We will not provide a CPT code for these services.  You will not see this portion of  services on your insurance EOB (Explanation of Benefits).  This amount is the responsibility of the client.  Pricing is available in the office.

  3. If your BCBS insurance is through the Medical College of Georgia/ GRU, your plan typically adds a deductible and lesser amount of coverage when accessing services away from the campus.

  4. Typically Value Options & Anthem will not authorize psychological or neuropsychological testing even when test requests are completed.  Appeals will not be filed for these insurances and testing services will not be billed to insurance when these services are denied.


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