Insurance

SuperBill

Pediatric and Adolescent Behavioral Counseling is a private counseling office and we do not bill directly to insurance or accept insurance at this time. However, we provide a SuperBill that you may provide to your insurance company for reimbursement.

Medicaid Insurance for Mental Health Services

Medicaid is available only to certain low-income people and families who are eligible. Rules about who is eligible and what services are covered vary from state to state. To learn more about Medicaid, go to www.cms.gov. You have the option of submitting your bill to Medicaid for reimbursement. However, you may not be reimbursed. If Medicaid reimburses you, they will pay you the rate paid to the specialist or amount that is included in your insurance policy. If you plan to submitting your bill to Medicaid, make sure you send it in as soon as possible. Medicaid has time frames in place for reimbursement (typically within 30 days). You must be insured and you may not receive payment for up to three months.

Private Insurance for Mental Health Services

Private insurance includes Blue Cross Blue Shield, HAP, Humana, Priority Health and more. Private insurance plans are paid by you directly, employers or other private organizations. You can submit your SuperBill for reimbursement. Depending on your mental health coverage, copay and deductible, your insurance provider may reimburse partial to full amount of services.

HMO and PPO Insurance

Some insurance plans work with certain health care providers and facilities, which are part of the plan’s network, to provide care at lower costs. This is called managed care. There are different kinds of managed care plans:

Health maintenance organizations (HMOs). These plans usually pay only for medical care within their network of health care providers. HMOs generally cost less than plans that offer a greater choice of providers.

Preferred provider organizations (PPOs). These plans cover more of your medical costs if you get care within the network of care providers. But they still pay some costs for care outside of the network.

Point of service (POS). You can choose between an HMO or a PPO each time you get medical care. These plans offer more flexibility in choosing doctors and hospitals.

Indemnity (fee-for-service) plans are different from managed care plans. The choice of doctors or hospitals you can use for your care is not restricted. Your health care provider is paid a fee each time you get medical care covered by the plan. The costs you have to pay on your own (out-of-pocket) could be higher than they are with some managed care plans.

Whether you have HMO, PPO, POS or indemnity, you can submit your SuperBill to your insurance company. If you have mental health coverage, your insurance provider may cover partial to full reimbursement for services.