Insurance 2018-09-21T14:18:12+00:00

Omni Psychotherapy, LCSW, P.C. is currently in-network with Cigna, Anthem and Empire Blue Cross Blue Shield (not the Empire Plan NYSHIP), Empire Blue Cross/Blue Shield Health Plus, and MagnaCare.

For out-of-network clients, we are happy to supply monthly statements with all of the necessary information for insurance reimbursement.

It is important to call your insurance company to find out exactly what mental health services are covered. All plans have certain rules, limits, and procedures. Sometimes a pre-authorization for services is required and often a deductible needs to be met before any reimbursements. In addition, there may be a limit to the number of visits allowed per year and a maximum amount of allowed charges per year and in a lifetime.

The following are some helpful questions that individuals can ask their insurance company:

  • Do I have outpatient mental health benefits?
  • If yes, do I need to see someone on the insurance company provider list only or am I also covered for out-of-network providers?
  • What is my co-pay and/or co-insurance?
  • Do I need to meet a deductible before receiving any reimbursements or paying any co-insurance or co-pays?
  • If a deductible needs to be met, how much is the deductible and how much of it have I already satisfied this year?
  • With out-of-network benefits being used, once the deductible has been met, what does the insurance company consider to be the usual and customary individual psychotherapy (code 90834) fee for a licensed clinical social worker in my geographical area and what percentage of that fee does the insurance company cover?
  • How many sessions per calendar year does my plan cover? Please note: The number of sessions per calendar year, even if unlimited, is not a guarantee that the company will ultimately approve and/or cover this number of sessions.
  • Is there a maximum amount of charges allowed per year or in a lifetime?
  • Do I need pre-authorization from the insurance company or a referral or approval from my primary care physician before my first appointment?