Navigating Insurance for Mental Health and Addiction Treatment: A Wave Treatment Centers Guide

Embarking on a journey toward mental health and addiction recovery is a significant step, but for many, the complexities of insurance can create unnecessary stress. At Wave Treatment Centers, we aim to simplify this process, offering transparency and guidance. This blog post is designed to help our working and insured target audience better understand how to navigate insurance for mental health and addiction treatment effectively.

Understanding Our Fee and Insurance Structure

Before we dive into the tips, it's crucial to understand Wave Treatment Centers' approach to fees and insurance:

Our Fee Policy

• Our fees vary depending on the clinician and type of service.
• Any questions about fees? Please feel free to contact us.

Our Insurance Policy

• We prioritize quality care, so we're an "out-of-network" provider for all PPO insurance plans.
• We don't participate in-network with most insurance plans and do not accept Medicaid or HMO commercial insurance.
• You pay the full fee upfront, but we assist you in submitting claims to your insurance for potential reimbursement.

Practical Tips for Insurance Navigation

1. Know Your Insurance Type

Understanding the type of insurance you have is the first step. PPO plans typically offer more flexibility for out-of-network providers like Wave Treatment Centers. If you have an HMO plan, unfortunately, our services won't be covered by your plan.

2. Contact Your Insurance Provider

The customer service number is usually on the back of your insurance card. Call this number to understand your benefits, especially for "out-of-network" providers.

3. Ask the Right Questions

• What percentage is covered for "out-of-network" providers?
• What is the "maximum allowed amount" for complex “E/M code 99214” visits and psychotherapy (code 90837) or TMS (code 90868)?
• Do I have a deductible for out-of-network providers? If yes, how much?

These questions will give you a clearer picture of your financial responsibilities and potential reimbursements.

4. Understand Common Procedure Codes

During your call with the insurance provider, you might be asked for a CPT (Current Procedural Terminology) code. At Wave, we commonly use:

• Initial Evaluation: 90792
• Follow-up Medical Visit plus Psychotherapy: 99213 + 90833 or 99214 + 90833
• For TMS: 90868

5. Track All Communication

Keep records of all conversations and correspondence with your insurance company. This can be crucial if there's a dispute or if you need to appeal a denied claim.

6. Utilize Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs)

These accounts can help cover medical expenses, including mental health treatments. Check if your employer or insurance company offers these options.

7. Consider Direct Reimbursement Plans

Some employers offer plans that reimburse for medical expenses directly. Check with your HR department to see if this is an option for you.

Your Wellness Journey, Simplified

At Wave Treatment Centers, we understand that the financial aspects of healthcare can be overwhelming. But remember, you're not navigating this complex landscape alone. We're committed to assisting you every step of the way, so you can focus on what's truly important—your path to recovery and wellness.

For further queries or to schedule your first appointment, feel free to reach out to us. Your well-being is our priority, and we’re here to make your journey as smooth as possible.