The NJ legislature passed a bill last year that requires many insurance companies to pay for ABA therapy. To see if your company participates in the program, please contact us for more information. Social Skills groups for Asperger’s children are also covered under this law.
For other psychological services, REAL does not currently participate with any insurance carriers, we will assist you by supplying the appropriate documents for services provided by our center. Our staff is available to help you with documentation for submission to your individual carrier.
The Regional Enrichment and Learning Center provides you with an “Encounter” ticket at the conclusion of each visit. This document identifies the specific services provided for that session, and includes the following codes, which your carrier will need to process your claim.
DSM-IV and ICD-9 codes are diagnosis codes. These are individual for each person. CPT codes identify the procedure that occurred on the date of service.
Psychological treatment is conducted in a variety of methods and the codes on your encounter ticket will identify what specific service was provided. However, services can be provided 1) Individually; 2) Group; 3) Testing or Evaluation; 4) or a combination of the above.
Psychological therapy benefits vary between insurance carriers. It is important to take the time to become acquainted with the benefits offered by your carrier's policy.
We suggest that you review your benefit booklet and documentation, or call your insurance company directly to learn about your benefits. Be specific in your questions, using terminology like “Psychological or Behavioral services, testing, or therapy.”
Ask about any limitations or “caps” in your insurance policy. These limitations or “caps” are usually in the form of a specific diagnosis and/or certain number of visits per year.
DO I NEED PRE-APPROVAL? Your insurance policy documentation or booklet or representative should be able to give details as to whether a referral or pre-approval is needed for our Psychological services.
If you find that a referral is required for pre-approval, make sure you contact your primary physician and obtain the referral before your child begins service.
It is not uncommon for the insurance company to pre-certify a specific number of sessions over a specific period of time. If they do, you should request the pre-certification letter. Have this letter mailed to you, not REAL, so you may keep track of the number of visits. However, always remember to keep good records. |