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Insurance Filing

There are many an app that helps patients who pay out-of-pocket to get reimbursed by their health insurance, at whatever rate is covered by your plan. 

IF your plan does not have a high enough coverage, you can petition your company for a SINGLE CASE AGREEMENT. This means that we will be treated as an in-network provider for you, and that our services will be covered as if we were an in-network provider. 

If you are not successful getting an SCA on your own, we have a provider who will pursue one for a flat fee of $100. You will need to pay for an assessment, and perhaps a second visit, in order for us to collect enough information to petition for an SCA. 

Factors that substantiate Atlanta DBT obtaining an SCA:

  1. we are intensively trained, and run a full protocol clinic

  2. the adolescent/family program is full protocol like Miller's research dictates. 

  3. we offer full RO-DBT, the highest efficacy treatment for anxiety, depression, trauma, PTSD, anorexia, and spectrum disorders. 

  4. we offer RO-DBT for adolescents!

  5. we are intensively trained in STAGE II DBT. 

  6. we are the only ones to offer STAGES III & IV DBT worldwide.

**Atlanta DBT does not endorse any particular agency. 

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Tips on working with your insurance company:

You can significantly increase the likelihood that your insurance carrier will cover therapy.  The following considerations usually indicate the need for your company to agree to a single case agreement whereupon an out of network provider is considered in-network for you. Here are the 3 greatest factors (but not limited to) in determining coverage:

  1. If you are a high utilizer of behavioral healthcare services. 

    1. If you have had a hospitalization

    2. if you are suicidal

    3. if you have been suicidal recently

    4. you are self harming (raging, cutting, drinking, purging, restricting--any behavior that harms your health or puts you at risk)

  2. if you live run by outside a specified ​radius from a true protocol program  with  Intensively Trained Practitioners

  3. if you require treatment for depression, anxiety, OCD, PTSD, anorexia or spectrum disorders--and you need DBT, then we are the ONLY program in GA that has an RO-DBT PROGRAM that meets this requirement specific for these illnesses.  Insurance companies generally agree to out of network services if they cannot provide the service in network, or if the distance is too great to travel elsewhere. 

CPT CODES that your company will ask for: 

90791: Initial Evaluation

90837: Individual Psychotherapy, 60 minutes

90853: Group Therapy (skills classes are coded as such, even though they last 2 full hours.)

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Insurance FAQ:

What is an out-of-network claim?

An out-of-network claim is a request for your health insurance company to reimburse a bill from a provider that does not have a negotiated contract with your health insurance company. If you are billed for the full cost of a visit directly by your provider, or they have told you they do not accept insurance, it is likely they are out-of-network.

Do all health insurance policies reimburse out-of-network claims?

No, not all policies reimburse out-of-network claims. Check with your insurance provider to see if your plan has out-of-network benefits. Typically, a PPO or a POS type plan will have some type of out-of-network coverage, while most HMO and EMO plans only reimburse for out-of-network care in the case of an emergency.

What is an in-network claim?

An in-network claim is usually filed directly by your provider with your insurance company. An in-network provider has a contract already in place with your health insurance company. For an in-network visit, you are only responsible for paying the copayment or for the portion of care not covered by your insurance.

What data should be on my bill?

To process your claim your bill will need to include your name, your provider’s name, your provider’s employment identification number (EIN or TIN) or social security number, your provider’s National Provider Identifier number, the code(s) for your diagnosis, the code(s) for any procedures, the date of your appointment (date of service), and the total amount of the bill. A bill with all this information is called a “superbill.”

A reimbursable superbill includes:

  • Provider’s name

  • Provider’s address

  • Provider’s phone number

  • Provider’s tax ID (EIN number)

  • Date-of-service

  • Amount charged

  • CPT code (procedure code)

  • ICD -10 code (diagnosis code)