Reimbursement for Counseling Costs

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1 Tom McCabe, MA, LPC Counseling for adults and mature teens PO Box Seward St, Rm cell Juneau AK Juneau AK fax tom@alaskapsychotherapy.com Reimbursement for Counseling Costs Take Care of Yourself First Choosing a counselor and beginning the conversation about what you want to change in your life can be a big deal. Preparing to use health insurance or other benefits to pay for counseling adds some complexity to that. If doing both at once feels overwhelming to you, I suggest you start with one or more counseling sessions that focus on you and your needs while postponing dealing with your insurance plan. This might mean that your insurance plan will not reimburse you for the first sessions but it will give you a chance to move past any feelings of being overwhelmed and to get ready to deal with the insurance claims paperwork. When you are ready, this document offers my suggestions for how to work with your health insurance plan to get preauthorization (if needed), how to prepare for reimbursement, and how to file claims for reimbursement. I am not a medical billing or insurance benefits expert so please treat my suggestions as just a starting point. Information you get from your health insurance plan should override what you read here. Table of Contents Take Care of Yourself First...1 Table of Contents...1 Understand Your Options for Reimbursement...2 Prepare to Submit Claims Gather Information...3 Prepare to Submit Claims Coordinate with Me...4 Submit Claims for Reimbursement...5 Get Help and Resolve Problems with Claims...7 Understand Medical Necessity and Insurance Coverage...8 Decide If Submitting Claims Is Worth It...9 Keep Up with Insurance Plan Benefits/Coverage Changes...10 Keep Up with Insurance Plan Enrollment Changes...11 Answer Common Questions...12 A. Checklist for Preparing to Submit Claims...13 B. Checklist for Submitting Claims for Reimbursement /6/2015 7:40 PM 8. Reimbursement for Counseling Costs - McCabe.docx Page 1 of 14

2 Understand Your Options for Reimbursement Private health insurance, usually provided through an employer, is just one way to help pay for counseling. Your might be able to pay for counseling with pre-tax income through a health or medical savings account, and you might be eligible for services covered by a federal insurance program such as Medicare or Medicaid. Get Reimbursed by Private Health Insurance If you or someone in your immediate family is employed or retired, the employer may offer group health insurance that covers the employee, spouse or domestic partner, and dependents. Similarly, you or someone in your family may purchase individual health insurance that covers you or your whole family. Both group and individual insurance plans are considered private because the government does not pay for them. Private health insurance may reimburse a big portion of your counseling costs, provided that counseling for your situation is covered by your insurance plan. Helping you submit claims to be reimbursed by private insurance is this document s main purpose. Pay From a Tax-Advantaged Savings Account HSA, MSA, HRA, FSA, etc. If you or someone in your immediate family is employed, that employer may offer some kind of taxadvantaged savings account which can be used to pay for health care costs, including counseling. These accounts go by a variety of names, including Health Savings Account (HSA), Medical Savings Account (MSA), Health Reimbursement Arrangement (HRA), or Flexible Spending Account (FSA). The general idea behind these accounts is that you or the employer set aside pre-tax money to pay eligible health care costs. This saves you from paying taxes on that income. Some of these accounts provide a credit or debit card you can use to pay for health care services, including counseling. Other accounts require you to pay for the services yourself and then submit receipts with a claim form to be reimbursed. This document does not offer specific suggestions about using these accounts to pay for counseling. Contact the account provider for more information on how to use the account. You may need to coordinate reimbursement between health insurance and tax-advantaged savings accounts, like coordinating reimbursement between multiple insurance plans. Use Medicare or Medicaid to Pay My counseling services are not eligible under the federal Medicare or Medicaid government insurance programs. If you are enrolled in Medicare or Medicaid, neither will pay for any of my counseling services but your private health insurance and/or tax-advantaged savings account might still reimburse some of the costs of counseling. The paperwork for private insurance claims may be a bit more complicated when you also are enrolled in government insurance. Keep Your Life Simple and Private Pay Entirely Out-Of-Pocket Participating in counseling does not mean that you must submit claims to your health insurance for reimbursement of your counseling costs. Similarly, you do not have to use a tax-advantaged savings account, even if you are enrolled in such a program. While these plans can reduce your financial costs, you may want to also consider their costs in your privacy, time, stress, and distraction from your counseling goals. More discussion of these trade-offs can be found in the Deciding If Submitting Claims Is Worth It section later in this document. Page 2 of Tomson McCabe 8/6/2015 7:40 PM

3 Prepare to Submit Claims Gather Information Before submitting claims for reimbursement, you need to gather some information about your specific insurance plan coverage and claims process. It s good if you have the time and energy to do this even before starting counseling, in order to make the most of your insurance benefits. I have prepared a printable form to help you gather and organize your insurance plan information (file named: 8.1. Insurance Coverage Questions - McCabe.pdf ). This coverage-questions form guides you through finding information that you will need in order to submit claims. This form also guides you though getting insurance plan preauthorization for counseling sessions, if that is needed. You don t have to use this form but you will need to somehow collect this information before submitting claims. The following numbered tasks give an overview of how to gather the information you need and refers you to the related parts of the coverage-questions form I provide. Set aside at least 30 minutes to gather the information. You will find the information by looking at an insurance plan ID/wallet card, plan booklet, or plan website and by talking on the phone with an insurance plan customer service representative. Note that this form is not useful for government insurance like Medicaid or Medicare; if you have government insurance, you should still complete this form for any private health insurance plans you are also enrolled in. 1. Gather Basic Information Page one of the coverage-questions form collects basic information about: (A) your insurance plan; (B) the person providing the insurance ( insured ); and (C) you, the counseling client. You will most likely find the plan information on your insurance plan ID/wallet card, plan booklet, or plan website; the rest of this information is personal. If you are enrolled in more than one insurance plan, complete page one of a separate coverage-questions form for each plan before proceeding with the next step. 2. Ask for Claims Submission and Coverage Information Page two, section D, of the coverage-questions form collects information you will need in order to submit claims. While some of this info may be in your plan booklet or website, some of it you will probably have to get by calling a plan customer representative. When speaking to a plan representative, be sure to start by saying that you want information about outpatient mental health treatment by an out-of-network LPC. If the representative has questions about the counselor providing services, then look at the bottom of page two of the coverage-questions form you ll find important details about me there in section G. This page also collects information about missed appointment fees and phone or Internet counseling; if your insurance covers either of those, I will need this information before I prepare paperwork for you to submit with your claims. If you know the mental health diagnosis we will be using to describe the medical necessity for your counseling, either because we have already met and decided this or because you have a diagnosis from an another health care professional, the form prompts you to ask the plan customer service representative if that specific diagnosis is covered by your plan. If you don t have a mental health diagnosis, skip that item on the form and proceed with the next step. 8. Reimbursement for Counseling Costs - McCabe.docx Page 3 of 14

4 3. Ask About Coordination of Benefits Page two, section E, of the coverage-questions form collects information about when your plan enrollment started and, if you are enrolled in more than one health insurance plan, how to coordinate claims between the different plans. You need these start dates even if you are enrolled in only one plan. If you are enrolled in more than one insurance plan (perhaps because you and your partner both have insurance through your employers or perhaps you are under 25 and both your parents have insurance plans that cover you), the insurance plans use a process called coordination of benefits to decide how the plans will share the costs of your health care. The main point of coordination of benefits is to ensure that all together the insurance plans do not pay for more than the total cost of your services and, additionally, which plan is most responsible for paying. Each plan may have its own policy about exactly how to coordinate benefits but in general the process works by deciding which plan is primary (first) and having that plan reimburse you as if it is the only plan. After the primary plan has reimbursed a portion of your costs, you send the secondary plan a claim with information about what the primary plan already paid; the secondary plan will only reimburse up to the remaining unreimbursed amount. Being enrolled in multiple plans can significantly reduce the final amount you pay out-of-pocket for counseling, but getting reimbursed by multiple plans requires extra paperwork and organization. When preparing to submit claims to multiple insurance plans, it is necessary to determine which plan is primary and which secondary (and tertiary if enrolled in three plans). Because there is no universal policy on coordination of benefits, you must ask each plan if it is primary, secondary, or tertiary. That will tell you what order you will submit claims to the insurance plans. If during counseling you enroll in an additional plan or lose enrollment in one of your existing plans, you will need to repeat this determination in order to know the new order in which to submit claims. 4. Get Preauthorization, If Needed Page two, section F, of the coverage-questions form prompts you to ask a plan customer service representative if you need preauthorization for counseling sessions and, if so, to record the details about your first preauthorization (sometimes called a precertification, prior approval or prior authorization). If preauthorization is required, you will need the authorization code and the other info you record here when you submit claims for those preauthorized sessions. Prepare to Submit Claims Coordinate with Me Share Insurance Plan Information In order to provide you with the paperwork you are required to submit with claims to your health insurance plan, I need some of the information you have gathered on the coverage-questions form or similar notes about your insurance plan. Bring all the information you have gathered to your next counseling session, including ID cards for all your health insurance plans, so that I can be sure I am providing you with the proper information for your claims. After you have shared with me the information I need, you should keep all of this information together in a binder or folder. Page 4 of Tomson McCabe 8/6/2015 7:40 PM

5 Discuss the Trade-Offs of Claiming Insurance Reimbursement Before I give you a mental health diagnosis and release that to your insurance plan, I recommend that we talk for a bit about the costs and benefits to doing this. Once mental health information is released, you cannot make it private again. We can also discuss the risk that your insurance plan will decline to reimburse any of your counseling costs, even if you do the work of submitting claims. For more information on this, read the sections of this document titled Understand Medical Necessity And Insurance Coverage and Decide If Submitting Claims Is Worth It. Sign Client Authorization Form Before I provide information to your health insurance plan, I require you to sign a form authorizing me to share your confidential information and assigning me permission to collect counseling fees from your health insurance plans (file named: 8.2. Client Authorization for Insurance Utilization - McCabe.pdf). Note that there is a separate version of this document for when you are a legal minor (file named: 8.3. Minor Client Authorization for Insurance Utilization - McCabe.pdf). When you are a legal minor, there is a very rare situation in which I may also need you to get a special authorization form signed by the person who provides your insurance; this is necessary only if your parent/guardian signing the authorization form is not also enrolled in the insurance plan themselves. Submit Claims for Reimbursement 1. Get a Superbill After we have finished a counseling session and you have paid for it, I will give you a superbill. This is a specialized health care invoice that you submit to your insurance company with your claim form, to show them what service you received, when, where, how much it cost, that you have already paid for it, and what diagnosis is associated with your counseling. You may request a superbill for each session or wait and request a single superbill with several sessions on it, if you want to submit a single claim form for several sessions at a time. 2. Track Preauthorizations If your insurance plan requires preauthorization of counseling sessions, you will need to track the preauthorization code or number, the expiration date of the preauthorization, the total number of sessions preauthorized, and the number of sessions used so far. I suggest you keep a careful list of your preauthorization information and mark each counseling session date that you are claiming under that preauthorization. That way you will not be disappointed to find that your plan has denied reimbursement because you ran out of preauthorized sessions or the preauthorization expired before your session. This will also help you know when to request another preauthorization. 3. Prepare and Send Claim Paperwork to Primary Insurance Plan Many health insurance plans have their own process and forms for submitting claims for reimbursement. You will need to follow your plan s instructions for completing a claim form, attaching the superbill, and sending it in. Some plans have a process for submitting claims online to speed their decision and allow you to track the process. If you are enrolled in more than one health 8. Reimbursement for Counseling Costs - McCabe.docx Page 5 of 14

6 insurance plan, start by submitting your claim to only the primary plan; later follow the additional step, #5 below, for coordinating benefits with more than one plan. When filling out the claim form, be sure to indicate that any reimbursement check should be mailed to you (or to the insured) and be made payable to you; sometimes insurance companies expect to make the check out to the health care provider instead. If you need help with this or any other part of completing the claim form, call your insurance plan and ask them to walk you through the details of filling out the form. If your insurance plan has you fill out the standard HCFA-1500 claim form, I provide a sample of this form pre-filled with the information about me and my practice (file named: Sample CMS-1500 claim form - McCabe pdf ). If this is the first time you are submitting a claim to this particular insurance plan, you should also include two additional forms with your claim, even if the plan doesn t ask for them. First, I can provide you with copies of the IRS W-9 form declaring my business tax identifier (file named: W-9 - Tom McCabe, MA - EIN.pdf ) this ID number is on all my superbills but, sometimes insurance companies still say they do not have it. Second, even if you are enrolled in only one insurance plan, sometimes you will need to submit a Coordination of Benefits (COB) form with your first claim to formally declare how many insurance plans will be involved. You can usually find this COB form on each plan s website. Including these two forms with your first claim to each plan reduces the risk that the insurance company will hold ( pend ) your claim until they receive this information. Before you send in a filled-out claim, make copies of everything and note the date you prepared the claim, in case your insurance plan loses the paperwork and you have to resubmit it all. Also keep a detailed record of any calls or s you ve had with your insurance plan you may need to show that you made a good-faith effort to follow your plan s instructions. Even if your plan has you submit claims online, I recommend that you keep your own copies of your submissions, in case their system loses or mangles your online records. 4. Track Insurance Plan Responses After your insurance plan receives your claim submission and has had time to process it (sometimes as much as six weeks), they will send you a form called an Explanation Of Benefits (EOB) which explains which claims they have denied and how much they are paying for the claims they approve. Sometimes they will instead send you a letter asking for more information before they can process your claim. Some insurance plans allow you to track the progress of your claims online; check with your plan for more information. When an EOB arrives, compare it to the superbill to see what your insurance plan decided to deny or reimburse. Check to see that they processed each session correctly, especially if there is more than one session listed on the superbill you sent them. You may disagree with their decision, in which case you can appeal the decision. Keep copies of all responses you receive from your insurance plan, including EOBs and letters requesting more information. Sometimes it takes weeks or months for you and your insurance plan to settle a claim and good records are the only way you can keep the details straight over that long a time. These records can be very helpful if you get into a dispute about coverage or payment with your insurance plan. Remember, your goal is to get reimbursed and the insurance plan s goal is to minimize their reimbursement costs, so you cannot assume they will make it easy for you. Page 6 of Tomson McCabe 8/6/2015 7:40 PM

7 5. Coordinate Benefits with More Than One Insurance Plan If you are enrolled in only one insurance plan, you are done your insurance plan has reimbursed you for what they cover and the rest of the costs are yours. If you are enrolled in more than one insurance plan, then after you receive the EOB from the primary (pays first) plan, you repeat the claims process for the secondary (pays second) insurance plan, using their claims process and forms but this time you will also need to attach the EOB from the primary plan so that the secondary plan knows what amount still remains unreimbursed. Don t forget to attach a copy of the superbill to the secondary claim. If you have a tertiary (pays third) plan, then once you have the EOB from the secondary plan, you will repeat the claims process a third time and attach both the EOB from the primary plan and the EOB from secondary plan to the tertiary claim. When there are multiple plans involved, keeping detailed, organized records of your claims and all EOBs is especially important. Get Help and Resolve Problems with Claims Private health insurance plans can be complicated and can change from year to year. A good place to start looking for help is your insurance plan s benefits booklet or website. Call a plan customer service representative if you need more help. Your employer may be able to help you, too, if they are the source of your plan; ask to speak to the employer s benefits officer. Although you are welcome to ask me if you have questions about working with insurance plans, keep in mind that I am not an expert in this and am not familiar with the details of the many different insurance plans that my clients are enrolled in. To help you, I may need to see the claims forms you submitted and any EOBs or information requests your plan has sent you, in addition to the information you shared with me when we prepared to submit claims. If you need help understanding the information on an EOB that you receive, see If a claim is denied, or reimbursement is less than you think your plan promises, you may be able to appeal that decision to get more reimbursed. For more information, see If you believe that a health insurance company has not acted as it should, you may also seek help from the State of Alaska Division of Insurance by filing a complaint about an insurance company at: If your health care costs or claims are complex, you may want to pay a Claims Assistance Professional (CAP) to help you. CAPs specialize in resolving complex problems with health insurance claims involving large dollar amounts, multiple health care providers, hospitals, clinics, and insurance plan denials. A directory of CAPs can be found at: 8. Reimbursement for Counseling Costs - McCabe.docx Page 7 of 14

8 Understand Medical Necessity and Insurance Coverage Counseling Can Help with More Than Your Insurance Plan Covers Your insurance plan is designed to support treatment of health problems so that you can return to normal functioning. Counseling can provide this sort of problem-oriented, medical-model treatment, in which case your insurance plan may reimburse some of the costs of counseling. Counseling can also help you achieve goals beyond just basic functioning; counseling can catalyze reaching greater potential and continuously expanding wellbeing and success in life. This growth-oriented, humanisticmodel counseling is more like seeing a personal trainer or nutritionist to improve your fitness and wellbeing. Problem-oriented counseling is more like seeing a doctor to treat a sickness. Growthoriented counseling is an investment in you and is beyond the design of insurance plans, so, if you are seeking this type of personal growth, you should not expect your insurance plan to pay for your counseling. However, because there is much overlap in goals and techniques for both approaches to counseling, sometimes your personal goals will coincide with services covered by your insurance plan. Insurance Plans Only Pay for Treating Illness Typically, your insurance plan is designed to pay some amount towards your counseling only if: 1. You have a condition that is a problem (mental health diagnosis) covered by your plan. 2. Your condition is severe enough that treatment is considered a medical necessity. 3. The counseling service (treatment) you receive is considered by your insurance plan to be appropriate for your condition. In some cases you must get preauthorization from your insurance plan before receiving counseling services. Your insurance plan may also want to monitor your progress in counseling, to confirm that your treatment remains a medical necessity and is obviously reducing problems in your basic functioning. When you come to counseling due to a diagnosed mental illness, we hope that eventually your condition will improve enough that counseling is no longer a medical necessity; at that point, your insurance plan may stop covering your counseling because you will be considered no longer mentally ill. Determining Medical Necessity Determining medical necessity is a complex combination of diagnosis, severity measurement, assessment of functional impairment, and clinical judgment about likely response to treatment. Determining medical necessity of mental health treatment is also controversial and sometimes takes a great deal of time and expertise. Consequently, insurance plans will often automatically pay part of the cost of initial counseling sessions in order to provide time to evaluate your medical necessity and response to treatment. Initially, your insurance plan determines if your counseling is a medical necessity by looking at a single code that represents your mental health diagnosis. You may have a diagnosis from prior medical, psychiatric, or counseling services, in which case you and I will review that diagnosis and see if it still fits your situation. Otherwise, we can discuss your situation and make a tentative diagnosis during our first meeting. Page 8 of Tomson McCabe 8/6/2015 7:40 PM

9 Keep in mind that over time I might change your diagnosis, possibly because we understand your situation better and a different diagnosis turns out to be more accurate, or possibly because you have improved significantly. As time goes on, your diagnosis and your insurance plan s determination of medical necessity may change in ways that lose or gain you coverage. At no time will I make diagnostic decisions based on what will or will not be covered by your insurance plan; I will stick to accurately describing your condition and level of function. If you are seeking personal growth through counseling and do not expect your insurance to reimburse you for counseling costs, then we can skip giving you a diagnosis and instead focus on your situation and your goals. Coverage (Medical Necessity) of Your Specific Diagnosis Once you have a diagnosis, we can make an educated guess about whether or not your insurance plan will cover your counseling initially. You can also call your insurance plan, tell them the diagnostic code and ask if treatment for that diagnosis is covered by your plan. The only way to be 100% certain of what your insurance plan will reimburse is to submit a claim and see if they approve it and, if so, how much they reimbursed. Decide If Submitting Claims Is Worth It Some clients choose to pay for their counseling entirely out of pocket, even those that have health insurance or a tax advantaged savings account. Privacy, avoiding diagnosis, simplicity, and focus are some of the reasons for this choice. Maintain Privacy When you submit a claim, you give your insurance plan or tax-advantaged account provider permission to look at and share some of your protected health information, including what your mental health diagnosis is, who and how often you are seeing them for help, and what problems and progress you are experiencing. Your insurance plan may request copies of your counseling progress notes or ask your counselor to talk to them in detail about how you are doing. Lots of people choose to share their private information with their insurance plan in order to reduce their out-ofpocket costs; federal law grants you the right to pay for your health care yourself and to disclose nothing to your insurance plan. If you are enrolled in an insurance plan where someone else is the insured (perhaps a spouse or parent), that person may receive the explanation of benefits forms that the insurance plan mails back in response to claims you submit for your counseling. If you do not want that person to know that you are receiving counseling services, and possibly the diagnosis you have received, you may have to avoid using that insurance plan at all. If you are in this situation, you can try calling the insurance plan and ask if they have a way for you to submit claims while maintaining confidentiality from the person who is providing your insurance. 8. Reimbursement for Counseling Costs - McCabe.docx Page 9 of 14

10 Avoid a Mental Health Diagnosis As discussed above in the section on medical necessity, mental illness or a mental health diagnosis are not the only reasons you might choose to participate in counseling. For those who seek growthoriented counseling, the negativity of a problem-oriented mental health diagnosis can conflict with their personal goals. You might decide not to submit claims to your insurance plans in order for us to proceed with counseling without having to assign you a mental health diagnosis. Keep in mind that once you submit claims for insurance reimbursement under a mental health diagnosis, you cannot make the insurance company forget that diagnosis. If you have previously seen a primary care doctor, psychiatrist, or other counselor for mental health help, and you or they billed your insurance, then your insurance company and the plan administration company probably already have a diagnosis for you in their records. Balance Time and Money It s very appealing to have your insurance plan or tax-advantaged account reimburse as many of your expenses as possible. However, if your insurance will reimburse only a small portion of your counseling costs, consider if it is worth your time and energy to submit claims for those small amounts. Take into account both the portion of each session fee that is reimbursable and any annual limits on the number of sessions or total reimbursement that the plan allows in a year. If your remaining deductible amount is more than you anticipate spending on all health care in the remainder of the plan year, then you might consider saving time by not asking for preauthorization or submitting claims for this plan year. If your anticipated counseling costs are less than your remaining deductible for the year, you might still want to submit claims in order to have your counseling costs count towards meeting your deductible meeting your deductible sooner may allow other health care costs you have during the year to be reimbursed. Simplify and Focus As you are probably already seeing firsthand, from reading this document, dealing with insurance plans is a distraction that may intrude frustratingly into your life. If you choose to seek reimbursement, you and I may need to spend valuable counseling session time discussing how to best communicate with reviewers from your insurance plan who are reassessing the medical necessity of your counseling. We may also need to spend time reviewing claim denials before you resubmit them. Regardless of the amount that your insurance plan says it will reimburse, you might choose to pay out-of-pocket to avoid paperwork or distraction during our counseling sessions. Keep Up with Insurance Plan Benefits/Coverage Changes If you receive information from your employer or insurance plan that benefits or coverage has changed for your insurance plan, you may want to revisit the information-gathering steps earlier in this document to see if these changes will effect how you submit claims or if you will gain or lose coverage for counseling. If you are enrolled in a plan provided by someone else, you may want to ask that person to remember to tell you about any plan changes that they are notified about, so that you are not surprised by those changes. Page 10 of Tomson McCabe 8/6/2015 7:40 PM

11 Keep Up with Insurance Plan Enrollment Changes Any time you become aware of an approaching change in your health insurance plan enrollment, coverage, or benefits, please tell me as soon as possible. Such changes can occur because of a marriage, divorce, new job, retirement, loss of job, birthday, or similar change for your spouse or parent; these sorts of qualifying events can happen at any time of the year. Many employers have an open enrollment period each year, during which the insured employee can chose to make changes to employment benefits, including health insurance. Planning ahead for such changes can tell us if we need to adjust how I prepare superbills or how you handle preauthorization, track your deductible or submit claims. If I don t hear about plan changes from you, it can take several months before I hear from the insurance plan, during which time I may have continued to document your services in a way that causes a new plan to then deny your claims. Switch Insurance Plans If you have been enrolled in just one insurance plan and are replacing that by enrolling instead in another plan, you can think of this situation as a two distinct steps: (1) end enrollment in an insurance plan, followed by (2) enroll in an insurance plan. You can smoothly handle each of those changes in that order, by following the suggestions in the next two subsections of this document. End Enrollment in an Insurance Plan After your enrollment in an insurance plan ends, you can still submit claims to that insurance plan for services that you received while you were enrolled, provided you do so within that insurance plan s normal claim time window following the service date. Counseling that occurs after your enrollment ends will not be reimbursed by that insurance plan. If you are losing your only health insurance and the plan is provided through an employer, COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that requires many employers to offer policyholders the option of temporarily continuing health insurance enrollment by paying the full premiums themselves. This is often expensive and meant as a short-term way of continuing coverage until a new job (and employer-sponsored health insurance) starts. For more information on COBRA, talk to the employer for which health insurance enrollment is ending. If you were or are now enrolled in more than one insurance plan at a time, follow the suggestions in the section below, titled Update Coordination Of Benefits After Every Enrollment Change. Enroll in an Insurance Plan As soon as you enroll in a new insurance plan, start from scratch gathering information about the new insurance plan s coverage, as described in Prepare To Submit Claims Gather Information, above. Do this whether it s your only plan or an additional plan. Then share that information with me, as described in Prepare To Submit Claims Coordinate With Me, above. The sooner we complete this, the more likely we are to correctly document your services for reimbursement by your new insurance plan. You might also need to start getting preauthorization from your new plan. If you were or are now enrolled in more than one insurance plan at once, also follow the suggestions in the next section. 8. Reimbursement for Counseling Costs - McCabe.docx Page 11 of 14

12 Update Coordination of Benefits After Every Enrollment Change If, after an enrollment change takes effect, you will be enrolled in just one insurance plan, then that plan will be primary and you should included an updated Coordination Of Benefits (COB) form with your next claim to the plan, clearly showing the date that your enrollment changes will become effective. If, after an enrollment change, you will then be enrolled in more than one insurance plan, you should update the COB between the plans. The most careful way to handle this is to call each plan, explain the change, ask which plan will be primary (and secondary and so on), and ask if you need to send an updated COB form to that plan. Note that each plan may require you to fill out its own unique COB form. Check the plan booklet, plan website, or ask a plan customer service representative if you are not sure what form to use. In theory you can send in a COB form as soon as you have the information necessary to complete it, even if the enrollment changes have not gone into effect yet. It might be less likely to confuse the insurance plan if you wait and include the new COB form with the first claim for services after the change of enrollment goes into effect that way the plan gets the COB form with the first claim where it makes a difference. Answer Common Questions Why don t you bill my insurance plan for me? Many health care providers will submit claims to your insurance company for you and later bill you for the remaining amount owed. For more information on how that works, see: Billing like this costs these health care providers a fair amount of money and time because it requires specialized insurance claims and billing skills and hard work. By making you responsible for your own insurance claims, I can stick to what I do best: counseling. This keeps costs down and helps me to focus on you, not on your insurance company. Yes, this is less convenient for you, but it does not increase how much you ultimately pay for counseling. This arrangement allows me to provide you with topquality counseling at a fair price with maximum privacy for you. Will my insurance reimburse for phone or Internet counseling? I am open to counseling via telephone or Internet video conferencing. However, some insurance plans do not cover counseling unless it is done face-to-face; live video conferencing is not considered face-to-face. Thus, reimbursement for telephone or Internet counseling depends on the details of your insurance plan. The coverage-questions form described earlier in this document (file named: 8.1. Insurance Coverage Questions - McCabe.pdf), prompts you to ask your insurance plan if they cover telephone and Internet counseling as well as additional questions to determine the coding details we would need in order to prepare superbills and claims for that type of counseling. If your insurance plan does cover telephone or Internet counseling, then talk with me well in advance so that we are prepared to document those sessions according to the requirements of your insurance plan. You can always choose to pay for phone or Internet counseling without being reimbursed by your insurance. Page 12 of Tomson McCabe 8/6/2015 7:40 PM

13 Tom McCabe, MA, LPC A. Checklist for Preparing to Submit Claims The following steps summarize my suggestions for preparing to claim reimbursement by your health insurance plans. 1. Consider if submitting claims is worth it to you (read that section in this document, page 9). 2. Gather information using the coverage-questions form I provide (file named: 8.1. Insurance Coverage Questions - McCabe.pdf): A. basic information about the plan; B. basic information about the insured person; C. basic information about you, the client; D. claims submission and coverage information for the plan; E. coordination of benefits (COB) information for the plan; F. if needed, get preauthorization for counseling sessions and record the details for later use on claims; 3. If you are enrolled in two or more insurance plans, repeat steps 2 A-F on a separate form for the second plan. 4. If you are enrolled in three or more insurance plans, repeat steps 2 A-F for each of the remaining plans, each on its own form. 5. Share information (and all insurance ID cards) from preceding steps with me. 6. Discuss with me any questions you have about reimbursement. 7. Sign 8.2. Client Authorization for Insurance Utilization - McCabe.pdf form. If you are a legal minor, there is a different version of this form: 8.3. Minor Client Authorization for Insurance Utilization - McCabe.pdf. 8. Save all the information you ve gathered, because you will need it when submitting claims for reimbursement to your insurance plan. 8. Reimbursement for Counseling Costs - McCabe.docx Page 13 of 14

14 Tom McCabe, MA, LPC B. Checklist for Submitting Claims for Reimbursement These steps summarize my suggestions for submitting claims for reimbursement by insurance plans. 1. Pay in full for counseling session(s) at the time of service. 2. Get superbill for sessions(s) from counselor. 3. If preauthorization was required by the primary insurance plan, then, in your preauthorization log, record the session(s) shown on the superbill. 4. Fill out primary insurance plan claim form for session(s) shown on the superbill. 5. Attach superbill to claim form. 6. If this is your first claim to this insurance plan, also include two more forms with the claim: a. IRS W-9 form, declaring my tax ID (file named: W-9 - Tom McCabe, MA - EIN.pdf ); b. Completed copy of this insurance plan s coordination of benefits form. 7. Copy all forms, including superbill, and put the copies in your records. 8. Submit completed claim form and attachments to primary insurance plan. 9. Record the date you submitted the claim. 10. Make yourself a reminder to check the claim status in five weeks if you have not received an EOB from the insurance plan by then. 11. When the EOB arrives, record receipt of EOB in your records. 12. Check the EOB for errors or reasons for you to appeal the insurance plan s decision. If you are enrolled in just one insurance plan, you are done. Otherwise, continue with the following steps to submit a claim to the secondary insurance plan. 13. If preauthorization was required by the secondary insurance plan, then, in your secondary preauthorization log, record the session(s) shown on the superbill. 14. Fill out secondary insurance plan claim form for session(s) shown on the superbill. 15. Copy superbill and attach to secondary claim form. 16. Copy EOB from primary insurance plan and attach to secondary claim form. 17. If this is your first claim to this insurance plan, also include two more forms with the claim: a. IRS W-9 form, declaring my tax ID (file named: W-9 - Tom McCabe, MA - EIN.pdf ); b. Completed copy of the insurance plan s coordination of benefits form. 18. Copy all forms and put copies in your records. 19. Submit completed claim form and attachments to insurance plan. 20. Record the date you submitted the claim. 21. Make yourself a reminder to check the claim status in 5 weeks if no EOB arrives by then. 22. When the EOB arrives, record receipt of EOB in your records. 23. Check the EOB for errors or reasons for you to appeal the insurance plan s decision. If you are also enrolled in a third (tertiary) insurance plan, then repeat steps 13 through 23 for the tertiary plan too, except that in step 16 copy and attach both the EOB from the primary insurance and the EOB from the secondary insurance. Page 14 of Tomson McCabe 8/6/2015 7:40 PM