Insurance

Are you in-network with my insurance?
All of the therapists at The Awakening Center are in network
with BCBS of IL PPO, Blue Choice PPO, and AETNA PPO. Some therapists are also in network with Cigna PPO. Even if we are not in network with your PPO, we can submit the claim to your insurance company directly or give you a receipt which you can send to your insurance company for reimbursement.

I have an HMO, are you in-network?
We are not in-network with any HMO’s. However, some of our
clients have gotten “authorization” to see therapists at The Awakening Center, especially because of our expertise in treating Eating Disorders. You need to ask your Primary Care Physician to write a referral to The Awakening Center.

Can you tell me what my insurance will pay for my therapy sessions?
We cannot tell you what your insurance coverage is – as each policy is different, even within the same company. We recommend you call your insurance company directly to verify your mental health insurance coverage before you begin
therapy.

Why do you recommend that I call to verify my insurance coverage before my first session?
Calling to verify your insurance coverage will eliminate any “surprises” which may interfere with your therapy later on. Your mental health insurance may have to be pre-certified or pre-authorized. If you do not get the sessions pre-authorized, your mental health insurance company can deny all claims and
pay NOTHING for up to a year! Another common “surprise” is that your insurance company will pay for six sessions without pre-authorization, and then require pre-authorization for future sessions. Future sessions can then be denied because they were not preauthorized. Another “surprise” is your medical
insurance and your mental health insurance may be covered by two different insurance policies. You may find that the insurance company that covers your medical claims is not the same company which covers your mental health claims.

Will my insurance cover my visits to the nutritionist?
Since everyone’s insurance policy is different, we cannot tell you if your insurance will cover visits to the nutritionist. Please call your insurance company to verify your insurance coverage – please ask if “Medical Nutrition Counseling” is covered. However, we have found that many of our clients are able to claim nutrition counseling on their insurance; some
are even covered 100%! You may need to get a “prescription” from your medical doctor in order for your insurance company to justify the need for these services.

Do you offer sliding fees?
The therapists at The Awakening Center all have a limited number of sliding fee appointments. We offer very-low-fee therapy with therapists-in-training for clients who do not have mental health insurance. Please be aware there may be a waiting list for very-low-fee therapy.

Do you accept Medicare or Medicaid?
We are sorry but we cannot accept Medicare or Medicaid as
these agencies do not accept the care of an LCPC or LPC.

I don’t understand how insurance works. Can you explain it to me?
Here is a link to a website that explains insurance terms in easy to understand terms:  Insura nceTerms

Will using my insurance for Mental Health services make my insurance company raise my premiums?
At this time your confidential information including diagnosis is protected by HIPAA (Health Insurance Portability and Accountability Act, 1996) laws and your employer and insurance company cannot use this information for any reason other than reimbursement for services.

Why do I need to ask about pre-existing conditions?
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, went into effect January 1, 2010. In simple terms this law says that your mental health insurance coverage has to be equal to your medical insurance coverage – if you work for a company with 50 or more employees. If you had a heart condition the insurance company could not say, “We’ll pay for 10 visits to a cardiologist and we’ll only pay for 15 days in the hospital.” Therefore, in theory, the insurance company is not supposed to limit the number of sessions with your therapist, nor put limits on inpatient hospitalizations. PLEASE NOTE: Laws regarding your insurance coverage, especially insurance coverage about pre-existing conditions, can change if Congress votes for these changes. If you are concerned about having insurance coverage in the future, we suggest that you contact your Senators and Representative and make your concerns known to them. You can find your Senator at www.senate.gov or Representative at www.house.gov.

What should I ask when I call to verify my insurance coverage?
Here are some suggested questions you may want to ask your insurance company about your mental health coverage. There is usually an 800 number on the back of your insurance card. We recommend that you print out this page and fill it out as you speak with the insurance company. Please make a copy of the answers for your therapist at your first session.

1) Name of insurance company :
2) Phone number that you called :
3) Date of call to insurance company :
4) IMPORTANT: Name of person you spoke with :
5) Say: “I would like to verify my insurance coverage for outpatient mental health services. Is my mental health insurance coverage the same company as (name of medical insurance company)?”
6) Is (Therapist name or The Awakening Center) an ‘in network provider’ – their tax id # is 20-5985467?
7) What is my deductible?
8) Have I met my deductible?
9) What will you pay for each session?
10) What is my co-pay for each session?
11) Is there a maximum number of sessions per calendar year?
12) Is there a maximum amount of benefit payments per calendar year?
13) Is there a pre-existing condition clause? What conditions are in the clause?
14) Do the sessions need to be pre-authorized or pre-certified?
15) What is the procedure for pre-authorization?
16) What is the “electronic address” to send claims?