Understanding Insurance
Dr. Mihalko is an in-network provider for Blue Cross (EPO, PPO, Blue Care Elect, Medicare PPO Blue, Network Blue, Blue Choice, and others including out-of-state Blue Cross plans) and a participating provider for Medicare Part B. If you have another insurance plan and it offers out-of-network benefits, it is possible that you could utilize your health insurance for psychotherapy.
Even if you do have on of the plans that Dr. Mihalko participates in, your treatment may not be covered in full. Each insurance plan has different co-pays, deductibles, and covered services. Deductibles, co-pays, and denied charges from your insurance company will be your responsibility.
Payment for services is expected at the time of service. If you have insurance other than those mentioned above, you will need to determine if you have an out of network benefit . Dr. Mihalko will assist you in determining your benefits and eligibility.
To assess what your insurance plan covers, contact the Mental Health/Substance abuse number on the back of your insurance card. This call will likely connect you with a customer service provider at the insurance company who will tell you your benefits.
Ask the following questions:
- What are my mental health benefits?
- Do I have an out of network benefit, and what is it?
- Do I have a deductible?
- Do I have a coinsurance amount?
- Do I have an out of pocket maximum?
- Do I have differing benefits for substance abuse/alcoholism?
- If I have a biologically based diagnosis, do I have unlimited visits as determined by medical necessity (Parity law)?
- What kind of authorization or certification do I need to obtain in order to start treatment?
- If I pay for any procedure out of my own pocket, how do I obtain reimbursement for doing so?
Write down the answers to these questions as well as the name and direct phone number of the person to whom you spoke.
Once you have a clear understanding of your benefits, we can discuss other steps that may need to be taken as they pertain to your specific therapeutic needs. For example, you may need to ask your insurance company for a case manager, to file an appeal, or to issue a denial so that coverage for any services provided may come from a third party payer.
Under the Tools heading on the left is a tab for a Health Insurance FAQ. In it is a glossary of various terms related to health insurance plans.