Using medical insurance
Thanks to today's parity laws, medically necessary mental health treatment should be reimbursed like any other medical treatment. However, insurance is complicated and it's important you know what to expect if you're counting on using insurance.
Playfair Consulting is a "preferred provider" with some insurers and is out of network with others. Please call or email for current paneling information. If we are in network with your insurer, we will handle billing for you and you will owe us an amount dictated by your copay, coinsurance, or deductible. If we are out of network with your insurer, we will provide you a "superbill" which you can choose to submit to your insurance company for reimbursement under your out of network benefits.
Learning about your plan
If you are counting on medical insurance or your EAP to pay for counseling services, it's important that you call your insurance company ahead of your first appointment and fully understand your specific plan. While Playfair Consulting can confirm if we're paneled with a specific company, some companies have many plans and many networks and it can be difficult for us to know, with accuracy, that we are covered under YOUR plan.
- First, make sure that you know which company covers your mental health services. Is it your regular insurance company or has it subcontracted mental health services to another organization? For example, an employee may have medical insurance through Blue Cross and mental health coverage through Aetna.
- Call and ask whether Katie Playfair or Playfair Consulting, LLC are considered in-network or out of network providers (Tax ID 46-3014896).
- Review the following codes with them to find out if they cover 90791 (first visit), 90837 (60 minute visit), 90834 (45 minute visit) and ask how they will be paid if submitted by us.
- Ask if there are any diagnoses they do not cover.
- Inquire about visit limits per year.
Don't forget that plans change every year! You will need to repeat this exercise at the beginning of each plan year if you want to be certain about how your insurance will pay. If you aren't that concerned, we can submit claims and see how they process!
Insurance companies/third party payers don't usually cover fees for missed appointments, telephone consultations, career counseling that is not secondary to a mental health issue, and certain other types of services. It is very likely that if we provide those types of services to you, they will not be reimbursed by your insurance.
Insurance companies require that we or you provide them some information about your treatment before reimbursing claims. On a claim or superbill, it is likely we will need to include your name, date of birth, other identifying information, a diagnosis or some justification for why we are working with you, and general reports of what we did in therapy (for example, a 60-minute session). Insurance is a highly regulated industry and so they ought to be keeping all of this information confidential but we do not have direct control over what they do with claim information once we submit it. If you are concerned about this information being shared with your insurance company, you can pay for therapy out of pocket.
If your symptoms do not meet your insurance company's definition of "medical necessity," they may not pay claims. Some carriers do not cover certain diagnoses. We cannot assign you a diagnosis you do not meet the criteria for, as that is insurance fraud. If you no longer meet criteria for your diagnosis, your insurance company may not cover ongoing therapy. We will make every reasonable effort to notify you if we suspect a change in your diagnosis may result in less reimbursement but we cannot guarantee that any insurer will cover any particular condition.