Insurance Reimbursement

6/14/2024

At Prism Counseling & Coaching, we strive to make our specialized services as accessible as possible. While we do not directly bill insurance, you may be able to receive reimbursement for our services through your out-of-network (OON) benefits by submitting a superbill. Here’s a step-by-step guide to help you navigate this process.

What is a Superbill?
A superbill is a detailed receipt provided to you after your sessions, which includes all the necessary information your insurance company needs to process a claim for reimbursement. This document contains service dates, descriptions, and the necessary procedural and diagnostic codes.

Steps to Submit a Superbill

Check Your Insurance Benefits
Contact your insurance company to verify your out-of-network (OON) benefits. Ask them about the reimbursement process for out-of-network services and what documentation is required. Inquire about any deductibles, co-insurance, and maximum reimbursement limits.
Receive Your Superbill
After each session, we will provide you with a superbill via Simple Practice. You will receive an email notification when the superbill is available in your client portal. This document will include the service date, description, and the fee for each service.
Prepare Your Claim
Gather all the necessary documentation as specified by your insurance company. This typically includes the superbill and a claim form provided by your insurer. Fill out the claim form accurately, ensuring all details match the information provided on the superbill.
Submit Your Claim
Submit the completed claim form and the superbill to your insurance company. This can usually be done via mail, fax, or online submission through your insurance provider’s website. Keep copies of all documents submitted for your records.
Follow Up
After submitting your claim, follow up with your insurance company to confirm receipt and check the status of your claim. Be sure to note any reference numbers or contacts you speak with for future reference.

Important Considerations

Payment Upfront: You are required to pay for our services upfront. After payment, you can then submit the superbill to your insurance company for potential reimbursement.
Insurance Coverage: While we provide the necessary documentation, we cannot guarantee reimbursement. Coverage for specialized services such as pastoral counseling (or faith-based counseling) and other services we provide, such as personal training and health coaching, varies by insurance plan. It’s essential to verify your coverage and understand that reimbursement is subject to your insurance provider’s policies.
Pastoral Counseling Licensure in Arizona: In Arizona, there is no option for licensure for pastoral counselors like there is in other states. Some insurance companies will still cover pastoral counseling if providers are certified (which we are) and there is a clear reason for care. It is important to advocate for the necessity of the counseling services you receive by explaining how they address specific mental, emotional, and/or spiritual needs.
Partial Reimbursement: If your claim is approved, reimbursement may only be partial as any copays and coinsurance may be deducted. However, it’s worth a shot, as some clients prefer to see if they can recoup some costs. Knowing that this is an option can be reassuring.

What to Do If Your Claim is Denied
If your insurance company denies your claim, don’t be discouraged. There are steps you can take to appeal the decision:

Request a Reason: Ask your insurance company for the specific reason(s) your claim was denied. This information will help you understand what needs to be addressed in your appeal.
Submit an Appeal: Write a formal appeal letter to your insurance company. Include the superbill, the initial claim form, and any additional documentation that supports the necessity and appropriateness of the services provided.
Supporting Documentation: We can provide additional letters and documentation to support your appeal. This might include detailed descriptions of the services provided and how they relate to your overall well-being. Additionally, having your doctor indicate that counseling is needed can significantly strengthen your appeal. Some insurance companies have reimbursed for pastoral counseling if it is prescribed by a doctor, though policies can change frequently.
Follow Up: After submitting your appeal, follow up with your insurance company to confirm receipt and check the status of your appeal. Keep detailed records of all communications.
Consultation: Sometimes, speaking directly with a representative from your insurance company can help clarify misunderstandings and provide further insight into what is needed for a successful appeal.

Navigating the insurance reimbursement process for pastoral counseling and other specialized services can be challenging, but we are here to support you every step of the way. By understanding your out-of-network benefits, preparing and submitting superbills, and following up diligently, you can enhance the likelihood of receiving partial reimbursement.

Remember, persistence and thorough documentation are key. If your claim is denied, don't be discouraged; we can assist with appeals and provide additional supporting documentation. Always keep detailed records and consider consulting additional resources or patient assistance programs if needed.

Ready to get started?

We invite you to schedule your appointment directly online via our client portal. A credit card is required to reserve your appointment, and payment must be made upfront. After payment is received, we will provide you with a superbill for submission to your insurance provider for potential reimbursement. Click below to book now:

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