CALLING YOUR INSURANCE COMPANY TO CHECK BENEFITS by r29355TZ

VIEWS: 0 PAGES: 2

									          CALLING YOUR INSURANCE COMPANY TO CHECK BENEFITS

Patients are encouraged to research their Outpatient Mental Health insurance
coverage before their first appointment. Please bring the completed following
information to your first appointment.

When you call your insurance company.
You will find a phone number on your insurance card for Customer Service or Benefit
Information. We strongly recommend you to call and ask the following questions
before your appointment. Otherwise you will be held responsible for the initial visit at
the cost of $180.00 payable at time of service.

Ask for Outpatient Mental Health Benefits. Do not ask for marriage counseling. Many
insurance companies do not cover marriage counseling.

   1. Can I see (name of therapist)_____________________at Madison Psychotherapy
      Center?
   2. Do I need pre-authorization?__________________________________________

   3. How do I get authorization?___________________________________________

   4. Authorization #:_________________________# of visits allowed_____________

   5. How long with this authorization last?___________________________________

   6. How do I get authorization for most visits?_______________________________

   7. Do I have a deductible or copay to meet?_________________________________

   8. What address should Madison Psychotherapy Center use to send
      claims?___________________________________________________________

   9. Name of person you talked to_____________________________Date_________

Your first visit
We will make a copy of your insurance card. We will also make a copy of this
completed form. Madison Psychotherapy Center will use the information you’ve
provided to bill your insurance company. Please come prepared to pay your copay
and/or deductible at time of services.

Madison Psychotherapy Center does NOT accept HMO (Health Maintenance
Organizations).

If you are not using or do not have insurance coverage, please discuss this with your
therapist prior to your initial meeting.
4/4/2012

								
To top