Billing at Madison Square: All You Need to Know
All of our therapists are Out-of-Network providers. This means that we’re not in-network or credentialed with any insurance companies.
However, if your plan has out-of-network benefits, your insurance company typically will reimburse you directly after you’ve met your deductible.
Typically, when a client receives care from an out-of-network provider, they will need to pay the full cost of the services upfront. Afterward, they can submit a claim to their insurance company for reimbursement. The insurance company will review the claim, determine the eligible amount to be paid based on their out-of-network coverage policy, and then issue reimbursement directly to the client.
5 simple steps to make the process easy
Complete Intake Paperwork
Confirm Your Benefits
Learn How It Works
Submit Your Claims
Get Reimbursed
Complete your paperwork on Simple Practice.
Once you’ve booked a first session with your therapist, you’ll receive an email from Simple Practice. The subject of the email will be “Client Portal” and will be sent from your therapist @simplepractice.com. Your client portal will have all of the intake paperwork that needs to be completed before your first session.
Look up and confirm your out-of-network benefits.
Going to therapy means that you’re making an important investment in your emotional health and well-being.
Our therapy rates vary by therapist and the length of sessions. At Madison Square, we think that cost shouldn’t get in the way of receiving quality therapy.
Are you unsure if you’re eligible for insurance reimbursement?
Dealing with insurance companies can be a confusing and frustrating experience. You can visit the website of our partner, Clarity Health + Wellness, to use their Insurance Benefits Lookup Tool to check your out-of-network benefits. This tool can provide an estimate of what you may expect to pay and be reimbursed for therapy. It’s important to keep in mind that this estimate is not a guarantee of reimbursement.* We suggest that in addition to using the calculator, you also call your insurance company’s customer service line to verify your benefits.
*Remember to confirm the estimated reimbursement amount with your insurance company as they have the most up-to-date information about your benefits. Additionally, if you are going to have telehealth sessions, it is important to confirm you are eligible for telehealth services.
QUESTIONS TO ASK YOUR INSURANCE REPRESENTATIVE:
“Does my plan include out-of-network benefits for mental health care? Specifically, for outpatient psychotherapy?” “And, telehealth visits?”
“Do I have a deductible for out-of-network mental health services? If yes, what is the remaining amount I will have to pay before my health plan starts to reimburse me for fees that I pay out-of-pocket?”
“What is the maximum allowed amount my plan will reimburse for CPT codes 90834 or 90837?”
“What percentage of the maximum allowed amount will my plan pay?” (This percentage of the maximum allowed amount is the amount you would receive as reimbursement.)
Insurers can be tricky and a rep may tell you that they don’t have this information. You may have to be persistent to get the answers.
3. Learn How It Works
What is a superbill?
A superbill is a detailed itemized statement or form used in medical billing. It is a document that your mental health provider gives to patients after a session, outlining the services rendered and the associated costs.
The primary purpose of a superbill is to facilitate the reimbursement process between patients and their insurance companies. It contains all the necessary information that insurers require to process claims and reimburse patients for covered medical expenses.
What information is included on a superbill?
Patient Information: Patient name, date of birth, contact details, insurance information, and any relevant patient identification.
Provider Information: Therapists name, NPI, Tax ID, practice address, contact details, and any other necessary provider information.
Date(s) of Service: The date(s) on which the medical service was provided.
CPT (Current Procedural Terminology) Codes: These are standardized codes that represent medical procedures and services. Each service provided during the appointment is assigned a specific CPT code.
Diagnosis Code (ICD-10): Diagnosis codes that correspond to the patient’s medical condition. These codes explain why the services were performed.
Description of Services: A brief description of the medical services or procedures performed during the appointment.
Place of service (POS): The code that is related to in-person or virtual visit. 11 is the POS code for in-person (an appointment takes place with the client in the therapist’s office). 10 is the POS for telehealth visits.
Units: The quantity of each service provided. For instance, if a patient received two vaccinations, there would be two units listed for that specific service.
Fee or Charge: The cost associated with each service rendered, along with the total charges for the appointment.
4. Submit Your Claims
If you are receiving superbills you will receive an email from Simple Practice on the 5th of every month for the month prior. This email will provide a secure link for you to download your superbill.
Submitting a superbill involves sending the document to your insurance company for reimbursement or keeping it for your records.
Remember that the specific process can vary based on your insurance company’s policies and the nature of the medical services. Always communicate directly with your insurance company to ensure you follow the correct procedure for submitting a superbill.
HOW TO SUBMIT A SUPERBILL TO INSURANCE
1. REVIEW
Double-check the accuracy of the information on the superbill, including service dates, service descriptions, codes, and costs.
2. CONTACT INSURANCE
Search your insurance website or contact them to inquire about their specific submission process, required forms, and any additional documentation they may need.
3. SUBMIT SUPERBILL
Depending on your insurance company’s requirements, you may need to upload electronically, mail, fax, or submit the superbill through an online portal. Some insurers might also require you to fill out a claim form along with the superbill.
4. KEEP A COPY
Make sure to keep a copy of the submitted superbill, claim form (if applicable), and any other related documents for your records.
5. FOLLOW UP
If you don’t receive reimbursement or any response from your insurance company within a reasonable time frame, follow up with them to inquire about the status of your claim.
5. Get Reimbursed
Once you hit your out-of-network deductible, your insurance company should send you a check in the mail reimbursing you for a portion of your sessions (amounts vary by plan). Usually this may take a few weeks for processing after you submit your superbill.
If your insurance or credit card information changes or expires, please make sure to update your information by emailing hello@madisonsqtherapy.com.
Ready to get started?