Dr. Budesa is currently accepting the following insurance policies:

  • Blue Cross Blue Shield PPO
  • Medicare

If you are not a member of the above insurance policies and still wish to see Dr. Budesa, you may do so through your Out of Network benefits.  Many people find that most of their expenses are reimbursed, costing them little more than their co-pay for seeing an in-network provider.

 

In order to make sure that you have the financial/insurance support to start and continue treatment, you must clarify what type of Behavioral Health benefits your insurance company offers for psychotherapy treatment.  (Your company may refer to these benefits as Behavioral Health or Mental Health; these terms mean the same thing).  Insurance companies have complicated procedures that change without notice.  You should document every contact you have with your insurance providers, to be used to defend your treatment, should the need arise.  This preparation will help to protect your treatment.  You may wish to print this page and have it on hand when you speak with your insurance company. 

  1. Call your insurance company customer number located on the back of your card and tell them you need to know the details of your behavioral health coverage.  Ask for information about the Out of Network (OON) benefits.
  2. Does your insurance provider provide OON benefits for behavioral health treatment?  These are the ones you will need to start treatment with me.
  3. If so, what is the deductible?
  4. What is the Percent of Coverage?  Is it 50%/50%, 70%/30%, or some other split?  Make sure you know exactly what side of the percent you will be receiving from the insurance company.
  5. Do you need Pre-certification (pre-authorization or pre-approval) for OON benefits to start?  Ask your insurance company if your therapist needs to call them before treatment starts in order to get approval to start treatment.  In rare cases, OON benefits also require an ongoing, or "Concurrent", review.  If this is not done ahead of time, you could lose any chance of receiving insurance benefits.
  6. How many sessions is your insurance company willing to pay for each year?  Does the year start each January or at some other point in time?  What is the lifetime maximum for behavioral health benefits?
  7. Is a special form needed to write claims?  Ask for the specific address where you will need to send your claims.
  8. Make sure to ask for the "turnaround time."  This means the length of time you will have to wait to receive in the mail the reimbursement check from your insurance company.
  9. They will ask for the "CPT Code," a method of classifying treatment categories.  The CPT code for a 45 minute session of individual psychotherapy is 90834; Diagnostic Interview (our first appointment) is 90791; Family therapy is 90847.
  10. You will hear the terms "R&C" or Reasonable and Customary.  R&C is the fee your insurance company has decided to pay per session.  The insurance company R&C price may be $100, or $70, or $150 per session.  Different insurance companies have different prices, or fees, even for the same type of treatment.  My fee will most likely be different from the fee, or price, that your insurance company uses for its R&C.

80 Pompton Ave. Suite 301     l     Verona, NJ 07044     l     (973) 897-7774     l     reginabudesa@gmail.com     l     NJ License #4289

Copyright, Regina Budesa, 2011