Verifying your health insurance coverage can be confusing! We recommend you contact your insurance company if you are considering starting services with Soma Therapy. It’s best to also verify benefits once a year or whenever your policy changes.
This webpage will help you know what to ask about coverage at Soma Therapy. We recommend that you print off this webpage to use during your conversation with your insurance company.
You can also use this form during your open enrollment period when you are reviewing your health insurance options and selecting a new plan (whether you’re going through your state’s exchange or your employer).
To ensure you get all the information you need from your conversation to verify benefits, we have included a phone script below. Have the following information ready before you begin your call (including these 4 questions for current clients. If you don’t know your providers’ names, feel free to call us.
These 3 questions are for current clients or clients placed with a provider only:
1) My individual therapist’s name ________________________________
2) Other providers I see for group, medical, or psychiatry services ________________________________
3) If applicable, any program or specialty services I’m currently in (IOP, Psychology assessments, or Spravato)________________
Insurance Verification Form and Phone Script
Phone script: “I’m going to Soma Therapy for mental health services and am calling to verify my benefits. First, I’d like general information about my plan. Before I ask, can I get some information about you and a reference number for this phone call?”
- Today’s date ________________________________
- Representative’s name First: _____________ Last Initial: _____
- Reference Number of Phone call (This is very important in case we ever need to call back or the remittance shows different information. The representative will provide this): _________________________
- Insurance company name: ________________________________
What is my:
- Policy # (verify it matches your card):
- Effective date ________________________________
- Office visit co-pay ________________________________
- Deductible ________________________________
- Out-of-pocket maximum (OOP max) ________________________________
- Do my deductible, co-pays & co-insurance apply toward my OOP max? ________________________________
- How much of my deductible have I spent this year? $_______________________________
- Do I need a referral for any services at Soma Therapy? Yes / No (circle one)
- If yes, who needs to refer me? ________________________________
- Is my provider at Soma Therapy in-network? Yes / No (circle one)
*Ask about the services below that apply to you*
Psychological testing
(Tell the representative that Soma Therapy uses psychological testing for some clients. We use CPT codes 96130 for 1 Unit, 96131 for 3 Units, 96136 for 2 Units, and/or 96137 for 10 Units)
- Is there a limit on the number of units of psychological testing per year? Yes / No (circle one)
- If yes, how many units of psychological testing per year? ______________________________
- Is authorization required for psychological testing? Yes / No (circle one)
Individual therapy
(Tell the representative that Soma Therapy uses CPT codes 90791 for initial appointments and 90837 for these services after the initial appointment.)
- What’s my co-pay / co-insurance (circle one)? $ _____________________________
- Is there a limit on the number of sessions per year? Yes / No (circle one)
- If yes, how many individual therapy sessions per year? ______________________________
- Is authorization required for individual therapy? Yes / No (circle one)
Group therapy
(Tell the representative Soma Therapy uses CPT code 90853 for this service.)
- What’s my co-pay / co-insurance (circle one)? $ _____________________________
- Is there a limit on the number of groups per year? Yes / No (circle one)
- If yes, how many group therapy sessions per year? _______________________________
- Is authorization required for group therapy? Yes / No (circle one)
Family therapy
(Tell the representative Soma Therapy uses CPT codes 90846 and 90847 for these services.)
- What’s my co-pay / co-insurance (circle one)? $ _____________________________
- Is there a limit on the number of sessions per year? Yes / No (circle one)
- If yes, how many family therapy sessions per year? _______________________________
- Is authorization required for family therapy? Yes / No (circle one)
Medical / Psychiatric Medication Appointments
Tell the representative Soma Therapy typically uses 90792 for initial and 99213 or 99214 for normal appointment CPT codes.
- What’s my co-pay / co-insurance (circle one)? $ ______________________________
- Is there a limit on the number of sessions per year? Yes / No (circle one)
- If yes, how many individual medical / psychiatry sessions per year? _______________________________
- Is authorization required for medical / psychiatry sessions? Yes / No (circle one)
- Are medical / psychiatric services delivered via Telemed covered? Yes / No (circle one)
Intensive Outpatient Program (IOP)
Tell the representative that Soma Therapy bills S9480 per day for this code.
- What’s my co-pay / co-insurance (circle one)? $ _____________________________
- Is there a limit on the number of days per year? Yes / No (circle one)
- If yes, how many IOP days per year? ______________________________
- Is authorization required for IOP services? Yes / No (circle one)
- Will psychiatric services or therapy services be additionally covered if performed on the same day as the IOP or will those be bundled in the S9480 cpt code? (yes/no)
- Please let us know all of the information you receive when working to update your billing profile.
ADDITIONAL NOTES:
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