How to Use Your Out-of-Network Insurance Benefits for Covering Art Therapy in Austin, TX
If you’ve decided to work with an art therapist in Austin, TX, great! This will be a creative journey ahead, one that lets you repair and rejuvenate through physical and nonverbal means. An appropriately trained and credentialed art therapist will support you by providing individualized services to help you reach your goals and literally create a better outcome for yourself.
Paying Out of Pocket for Austin, TX Art Therapy
Now that you’ve made your decision about working with an art therapist in Austin, TX, it’s time to think about how you’ll pay for services. Paying out of pocket? That’s usually pretty straightforward (don’t forget to ask for your Good Faith Estimate, though, as the federal No Surprises Act entitles you to receive this document prior to the start of services).
Accepting Insurance Isn’t the Norm for All Art Therapists in Austin, TX
Not all art therapists accept insurance, and they have their reasons for this. Most have to do with concerns about the confidentiality of your treatment records, the low payments offered by the insurance companies, and/or the amount of hassle it takes to work with these giants.
Using Your Insurance to Cover Austin, TX Art Therapy
If you’re planning to use insurance for covering services provided by an art therapist in Austin, TX, the biggest thing to know is whether your policy is associated with a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). It will say on your insurance card, and the difference between the two is significant.
Using an HMO Insurance Policy to Cover Art Therapy in Austin, TX
An HMO will only let you work with an art therapist who’s paneled on your insurance company’s rosters. You can go to your insurance company’s website to see who their approved behavioral health providers are, but there won’t be anyone listed who’s been specifically identified as an art therapist (not in Texas, anyhow).
Instead, you’ll have to find an art therapist and then look for that person’s name on your insurance company’s website, or you can just call the art therapist to verify whether they accept your insurance. Given that most insurance companies don’t do a great job of keeping their online rosters up-to-date, calling the art therapist might be your best bet.
Using a PPO Insurance Policy to Cover Austin, TX Art Therapy
The rest of this article is primarily geared toward anyone who’s got a PPO. If you have a policy that’s associated with a PPO, your insurance company encourages you to work with providers who are “in network”. That’s essentially like an HMO arrangement, where you can go online to see who their in-network providers are (assuming the rosters are current, which likely they’re not).
Your experience with an Austin, TX art therapist will be less of a financial investment on your part if you use an in-network provider. HOWEVER, be aware that you have the freedom to see a provider who’s not associated with your insurance company. This is called an “out-of-network” (OON) provider.
Working with an Art Therapist in Austin, TX Who’s an Out-of-Network Provider
Using an OON provider means that you’ll be paying more for the privilege of working with an art therapist of your choosing. Some OON art therapists will bill your insurance company for the allowable rate, and you will have to make up any difference between the allowable rate and the art therapist’s rate.
Others will give you a superbill, upon request, so you can submit it to your insurance company. If you get a superbill, it means that you’ve paid the therapist out of pocket and are using the superbill to request that your insurance company reimburses you for the allowable amount.
Understanding How Your OON Benefits Will Cover Austin, TX Art Therapy
What you’ve read so far might sound easy-breezy-peasy, but in order to use your OON benefits, you need to know a host of information that will help you navigate your insurance company’s maze. The research activity will pretty much fall on your shoulders, as you are the policy holder, not the art therapist in Austin, TX.
Your “To-do” List for Using OON Benefits to Cover Art Therapy in Austin, TX:
Find out how long the art therapist’s sessions are and what the CPT code is for this. A CPT code is the Current Procedural Terminology code per the American Medical Association.
Ask your insurance company what the allowable rate is for the CPT code per your insurance plan. You should also ask about the allowable rate for CPT code 90791, which is the initial assessment.
Depending on your situation, make sure you inquire about whether there’s any difference in the allowable rate for psychotherapy that’s conducted via telehealth and/or out of the art therapist’s home office. Some insurance companies have been getting stingy about these arrangements, and you don’t want any negative reimbursement surprises if your art therapist provides online therapy and/or works from home. This means you should also ask if there’s a limit on the number of sessions you can have through telehealth and/or in the therapist’s home office.
Ask what your deductible is for OON services. This is the amount you have to pay before insurance will kick in. Note that there’s usually a difference between your in-network deductible and your OON deductible, and the OON one is typically higher.
Find out what your policy period is. Does your policy period begin on Jan. 1 and end on Dec. 31? Not all policies do, so inquire about the dates.
Ask how much you’ve already spent toward your OON deductible in the current policy period. This will let you know how much or how little you’ll have to spend during the remainder of your policy period before your OON deductible is met and insurance kicks in.
Your policy might include a coinsurance responsibility on your part, and that is what you’re responsible for paying AFTER you’ve met your OON deductible. For example, perhaps insurance will pay for 80% and you’ll pay for 20% after the OON deductible has been met. Find out what your coinsurance responsibility is, if any.
Helpful Tips for Using Austin, TX Art Therapy Superbills to Seek Reimbursement from Your Insurance Company:
You should request that your art therapist give you a superbill after every session rather than monthly. This is because insurance companies are constantly changing their internal policies, and they have the right to stop reimbursing you if they decide they’ll no longer cover things like online therapy and/or therapy that’s provided in the art therapist’s home office. Sudden changes could prevent you from being reimbursed for several sessions if you’re only getting one superbill per month, where that would not be the case if you received (and submitted) a superbill after every session.
Ask what the insurance company’s preferred method is for submitting superbills. Doing it “their” way can make a huge difference in terms of how speedily the reimbursement process moves along.
Find out what kind of deadlines your insurance company imposes on the submission of superbills. For example, if you have a session in May but don’t submit the superbill until October, is that too late?
Ask your insurance company how long it takes to get reimbursed after you’ve submitted a superbill “their” way. That’ll help you keep track of your expected payments, and you’ll be able to advocate for yourself with an insurance company representative if an expected payment doesn’t arrive on time.
You might want to investigate an app called Reimbursify, which is a platform for submitting superbills in a way that eliminates hassle. Reimbursify will serve as the intermediary between you and your insurance company and advocate on your behalf if there’s any problem or delay with your reimbursement process.
Letting Your Insurance Company Become Involved with Art Therapy in Austin, TX
A final note to consider when entertaining the idea of using insurance to pay for art therapy in Austin, TX, whether through an HMO or a PPO, is that involving your insurance company in any way will allow it to dictate the terms of your treatment. You may find that the number of sessions is limited, the length of each session is limited, etc. Your confidential treatment records will be reviewed periodically by someone within the insurance company in order for services to be authorized; medical necessity is a requirement if you’re going to invoke your health insurance.
Empowering Yourself to Make Decisions About OON Benefits and Austin, TX Art Therapy
Money matters! It’s a central component of our lives, and it’s important for you to realistically venture into Austin, TX art therapy with a solid understanding of what your financial investment will look like. Paying attention to the bulleted items in this article will help you understand how your OON benefits work and empower you to make decisions about how you use them.
Focusing on Client Care in Austin, TX Art Therapy
As for this Austin, TX art therapist, I do not work with insurance companies, meaning I don’t see clients with an HMO insurance policy, but I do take private pay clients as well as clients who have a PPO policy and want to use their OON benefits. I provide superbills to PPO clients who request them. This arrangement prevents me from spending time wrestling with insurance companies so I can keep my focus on client care, which is right where I want it. The clients I serve like it that way.
Do You Need a Complimentary Austin, TX Art Therapy Consultation?
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If you need a little more info about how I support people in using their very own hands and eyes to break out of the same ol’ same ol’ and into new ways of relating to themselves and the world around them, visit my About page. Isn’t it about time for you to step out of the shadows and into the light?