Contact Me:
MAILING ADDRESS:
Shante Fauskee, LLC 5995 Oren Ave N Ste 209 Stillwater, MN55082 |
PRACTICE LOCATION:
5995 Oren Ave N Ste 209 Stillwater, MN55082 |
Local Bus Route:
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FREQUENTLY ASKED QUESTIONS
How can I find out if you are in-network with my insurance plan? Most insurance companies offer a provider search online that is connected to your specific plan. This typically requires you to know the type of plan you have or for you to log-in to your online account. You can also call the customer/member service number listed on the back of your insurance card.
Can you help me verify mental health insurance benefits? Yes, I can. I will need you to provide the following information: your first and last name, date of birth, a copy of the front and back sides of your insurance card, and how you'd like to receive your information. This information can be sent to me via text, email or fax using the Fax Me button above. Once I have this information it may take 1-2 business days to get back to you with benefit information.
Do you balance bill as an out-of-network provider? No, I don't. I honor the allowed amount determined by your insurance company.
You are out-of-network with my insurance plan, I can't afford your standard rates but I would still like to see you. Do you offer a reduce rate? I can offer a limited number of clients reduced fees through the Open Path Psychotherapy Collective. You can contact me to see if I have any openings available. If I have no openings available for psychotherapy reduced fees, I may be able offer you another counseling or coaching service that has lower rates then psychotherapy.
How are out-of-network insurance claims handled? I will submit the insurance claim directly to your insurance company. Many insurance companies will only make payment to their members for out-of-network services, which means clients are required to pay the full standard rate for their sessions until their allowed amount is confirmed. Insurance companies do not typically disclose their allowed amount for out-of-network services and this information cannot be confirmed until an the claim is processed and an estimation of benefits generated. When clients pay over the allowed amount, the extra amount is credited to their client account for future sessions as long as the client is actively participating in services.
What does it mean when you say a service is not covered by insurance? In order for psychotherapy services to be covered by insurance they have to be treating a mental health diagnosis that is covered by your plan and services need to be considered medically necessary. This means that your symptom impacting functioning and if left untreated could result your symptoms worsening, lead to a higher level of care needed, or contribute to other health conditions. If your symptoms do not meet the criteria for a mental health diagnosis and/or you are receiving services that fall under Other Conditions That May Be a Focus of Clinical Attention in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, then your services would not be covered by your health insurance benefits.
UNDERSTANDING HEALTH INSURANCE BENEFITS
DEDUCTIBLE: The amount you have to pay for health care services before your insurance plan will pay any portion of your services. For example, if your deductible is $500 you will have to pay the $500 out-of-pocket until your deductible is considered satisfied. Once your deductible is satisfied, your insurance plan will begin paying a portion of your health care costs that are covered by your plan.
Your plan may encourage you to use in-network providers by charging you lower deductibles, co-payments and co-insurance amounts. The deductibles for in-network and out-of-network services do not necessarily cross apply (meaning you have separate deductible to meet). For example, you have a $500 in-network deductible and a $1,000 out-of-network deductible. Even if you have already met your in-network deductible, you would still need to meet your $1,000 deductible if you choose to see an out-of-network provider.
Your plan may encourage you to use in-network providers by charging you lower deductibles, co-payments and co-insurance amounts. The deductibles for in-network and out-of-network services do not necessarily cross apply (meaning you have separate deductible to meet). For example, you have a $500 in-network deductible and a $1,000 out-of-network deductible. Even if you have already met your in-network deductible, you would still need to meet your $1,000 deductible if you choose to see an out-of-network provider.
CO-PAYMENTS: A fixed dollar amount you are responsible for paying to your provider when you receive a covered health care service. Insurance plans, typically have different co-payment amounts for different services.
CO-INSURANCE: The percentage of a covered health care services that you are responsible for paying to your provider after you have meet your deductible. This percentage is based on the allowed amount of the service. For example, if the health plan's allowed amount for a 60-minute psychotherapy sessions is $100, your co-insurance payment of 20% would be $20.
Allowed Amount: The amount your plan pays for covered services. For example, my standard fee for a 60-minute psychotherapy session is $150 but each insurance company has an allowed amount for in-network and out-of-network services. The allowed amount varies between insurance companies.