Will my insurance cover the treatment?
Each person’s insurance is unique. The Awake DBT program is out-of-network. Most individuals with PPO plans will have some level of coverage from their insurance (usually 50-70%). We recommend you call to determine if you have an out-of-network deductible. Also, we encourage you to determine exactly what your insurance will cover.
The procedure code for individual therapy is 90834 and the procedure code for skills group is 90853. The insurance carriers typically ask for our license level (which is MFT) and our zip code (which is 95125). We encourage you to determine what the what the maximum coverage will be for each of these codes. Carriers usually quote the reimbursement as a percent of their ‘Reasonable and Customary” or maximum reimbursable amounts for each service.
We typically ask for payment weekly and provide a superbill at the end of each month for you to submit to your insurance company for reimbursement.
If this cost outlay does not work with your budget, we can try to negotiate a single case agreement (SCA) to develop a contract with your insurance to treat you. It typically takes a few weeks to negotiate and finalize an agreement. We will enlist your help to initiate the process. We hope to come to agreement with your insurance company. However, we can’t guarantee the SCA until negotiation is completed and contract signed. You may need to pay out of pocket till the time the agreement is secured. If the insurance can back date, we could reimburse your initial cost outlay.
For more ideas on how to be successful in attaining a SCA, see attached.