Coverage

At this time, we do not accept insurance coverage. Reimbursement Request paperwork can be provided upon request, and can be submitted directly to your insurance provider

Payments, including session fees and co-payments, are due at the beginning of each session. Equilibrium Mental Health accepts payments in the form of cash and credit card.

Navigating Out-of-Network (OON) Coverage

Equilibrium Mental Health, LLC (EMH) is an out-of-network provider and we do not accept insurance. However, we are delighted to provide for you a receipt for reimbursement of mental health services. We recognize that navigating this process might prove difficult, and the EMH staff has assembled a list of tips and tricks to expedite the process.

Please contact your insurance company to verify that they will accept a receipt for reimbursement. We hope that you find these tips and steps helpful:

 

Tips

  • You should anticipate a 15–30-minute phone call.

  • Be prepared to share client information such as name, date of birth, address, phone number, and additional information.

  • It could be helpful to have a pen and paper handy to take notes.

Yoga by the Ocean
Image by Nathan Anderson

Questions to Consider Asking

  • Are there out-of-network benefits for this policy?

  • Do I have a mental or behavioral health policy with out-of-network benefits?

  • What are the requirements to use out-of-network benefits?

  • Is prior authorization required?

  • Is a referral required from my primary care physician?

  • Do I have an out-of-network deductible?
    If yes,

  • What is my out-of-network deductible?

  • How much of my out-of-network deductible has been met?

  • What is the start date of the calendar year my out-of-network policy is based on?

It might also be helpful to ask your insurance provider if the following Current Procedural Terminology (CPT) codes are covered. Be sure to ask your insurance provider what the usual and customary fee is and what percentage do they cover?

Descriptor of Service & CPT Code

Diagnostic Interview - 90791

Individual Psychotherapy (60 Minutes) - 90837

Family Psychotherapy (without patient present) - 90846

Family Psychotherapy (with patient present) - 90847

Multiple Family Group Psychotherapy - 90849

Group Psychotherapy - 90853

Other Considerations

  • Is there a session limit? What is the limit? How many sessions do I have?

  • What percentage of services is covered/what is my co-insurance?

At the end of the phone call, be sure to document the date/time you called, the representative’s name, and the reference number for the phone call.