Lisa Wessan, LICSW on
Insurance and Cost:
How to use your Out of Network
Benefit for Therapy with Me
(and other healthcare needs)
After many years as an "In Network" provider, as of January 1, 2018, I stopped accepting copayments for insurance covered therapy.
Clients submit fees with checks, PayPal and other sources of payment. (I have also been reimbursed by DCF for attendees in my DBT Skills Groups).
I can, however, work with your "Out of Network" (OON) insurance benefit payment method outlined below.
It is your responsibility to contact your insurance company and discover how your OON benefit will reimburse you. If your plan has an OON benefit, you can see licensed and board certified clinical providers that are not "In Network" with your insurance company.
Unfortunately, most HMOs, any version of ObamaCare and the Commonwealth's MassHealth do not offer OON benefits.
OUT OF NETWORK
Once you have contacted your insurance carrier and know if you have the OON benefit, you will be reimbursed either 80, 70 or 60 percent of your expenses based on your plan.
The first Monday of each month I will prepare your statement for the previous month.
This will include information your insurance company will need to fulfill your OON benefit.
You then submit my statement along with your insurance company's OON form and either mail it in or submit it on their web site.
In order for me to prepare an OON statement, I need:
1. NAME of Subscriber.
2. Insurance carrier name and your account number.
3. Group # or name of company.
Once I have this data I can complete the statement for reimbursement.
Please mail your OON packet via CERTIFIED MAIL. This is essential, for the insurance companies are notorious for saying "We did not receive your claim." You will then receive reimbursement from your insurance company, usually within 30 days.
Keep in mind you usually have 90 days to file from the date of service in order to be reimbursed. Please submit your claims in a timely manner to avoid denial of payment after 90 days has passed.
If your insurance carrier requires the provider to fill out forms, please bring these to your initial sessions. I will complete the necessary paperwork as needed.
Sessions are paid for at or before the time of our session. I never work on a credit system, or "lay away" plan. It's much too complicated and takes away from our clinical work.
If you have any questions, please contact your insurance carrier and they can clarify what is possible for you concerning your OON benefit.
You and I will discuss payment options on the phone once you have decided you would like to work with me.
Onward and Upward,