Insurance Verification

How do I find out what I owe if I have insurance?

Illustration of a key pointed at a 45° angle overlapping other images

What does insurance cover?

You are not alone. Insurance can be confusing and overwhelming for many people. We are here to help you and empower you to find out exactly what your insurance policy covers and what you are responsible for paying.

Not all insurance policies are the same, but there are some basic terms for you to know in order to better understand what your insurance will cover.

A pile of paperwork spread out at various angles

Insurance terms

Premium - This is how much you pay each month for your insurance plan

Deductible - Some plans require you to hit a deductible. A deductible is the amount of money you have to pay out of pocket before your insurance will help pay for any services.

Coinsurance - Once you hit your deductible, your coinsurance kicks in. Coinsurance is the amount you are responsible for and is calculated as a %. For example, if you have 20% coinsurance and you use a healthcare service that costs $100, then you would owe 20% of that, which comes to $20 per session.

Co-pay - Some plans have co-pays. These plans don’t require you to pay a deductible before insuance helps pay for services. You have a set amount you pay for each visit. The amount of your co-pay is decided by the insurance company.

Out-Of-Pocket Max - Often confused with “Deductible”, out-of-pocket max is the most amount you are expected to pay for your covered healthcare needs in a calender or plan year. It is often more than your deductible and puts a cap on how much you will have to spend in a year.

So how do I find out what I will pay for therapy?

Expand sections below for a detailed walkthrough

We are in network with most major Insurance companies including BCBS, United, Optum, AETNA, Cigna, Baylor Scott & White, Oxford, Oscar, Medicare, Medicaid, Tricare, and the list is growing. For an updated list, please call and ask our admin team at 214-385-5445.
On the back of your insurance card is a customer service “1-800” number. This is your best option to get accurate information from your insurance company about your policy. Please make sure you have your card with you when calling. The insurance representative will need some of the information that is on the card, as well as your Social Security Number, DOB and address for verification purposes.
Insurance companies will need to know our National Provider Identifier, or “NPI.” This is just a number assigned to our facility for verification. We have 2 different NPIs so please provide both when prompted by the insurance company representative. If they accept either NPI number, then we will be able to bill your insurance.
-NPI 1225535644
and
-NPI 1003574468
If you have an HMO Plan, you may need to get a referral from your PCP(Primary Care Physician) before being able to attend sessions. Please verify this with your insurance company when you call.
CPT billling codes are how the insurance company knows what services we are providing and what the cost will be. You will need to give these to the insurance representative for them to give you a quote. We provide many services, but the 2 most common are:
Initial intake session - 90791
Talk Therapy session - 90837
This can happen, but is usually because you have a deductible to meet or co-insurance and they need us to verify rates for you. If this happens, please ask the following questions:
Do I have a deductible to meet? If so, what is it, and how much have I paid towards it?
Do I have co-insurance, and if so what it is?
Once you have this information, please email us at Manager@roomforchange.info and we can add this to your file.
We have cash pay rates we can easily quote because we are in full control of our cash rates. Insurance rates are not in our control. Those are set by the insurance companies.
Additionally, there are hundreds of types of insurance policies from each insurance company and we are unable to verify which policy you have purchased. Since Room For Change is not the customer for the insurance companies, they do not respond as quickly or with as much care as they will for you.
There are some plans that luckily cover 100% of mental health costs. However, most do not fully cover costs until the out-of-pocket max is reached. Most plans are deductible plans or co-pay plans. Understanding your policy is valuable information and we hope we can help you do just that.
Call our main line at 214-385-5445 or email us at manager@roomforchange.info and let our team know so we can make adjustments on your out of pocket responsibility. Once claims are returned to us after your first session, we will make the necessary adjustments and encourage our clients to contact us if they see a discrepency on their end.