Confusion on mental health coverage in regards to play therapy for my daughter. South Dakota, USA
Hello!
We were recommended to seek play therapy for my 5 year old daughter by her pediatrician to help with anxiety, sleep issues, and outbursts. I found a provider in-network per our insurance company's directory, but now insurance insurance will only cover the intake appointment, but not the actual therapy appointments unless the deductible for the plan has been met. I'm confused because some of what I'm reading online seems to say that insurance companies are not allowed to charge more for mental health services than they are for physical or allow different parameters regarding hospitalizations, treatments, etc. Does therapy then not fall under that umbrella or is that not considered a true mental health treatment?
Here are our policy details:
In Network Office Visit: $25 PCP/$25 Specialist
Family Deductible: $5000
Family Out-of-Pocket: $10,000
Billing codes used would be:
90791 (Intake)
90834 (45 minute session)
90837 (60 minute session)
90846 & 90847 (family sessions if needed)
The mental health section of my coverage paperwork is pretty vague but states under the common medical events section:
If you need mental health, behavioral health, or substance abuse services:
For a Network Provider:
Outpatient services – Office visit: $25 copay / visit
Other outpatient services – Office visit: 20% coinsurance after deductible met
That last one is obviously what they're classifying it as but I guess I just don't understand how this wouldn't fall under an outpatient services office visit.
Can anyone help me understand or advise if there's another way we can go about it to make it fall under insurance coverage?
submitted by /u/xxdrunkenslothxx
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