ketamine insurance coverage ballen health wellness

 

Our Clinic does not accept insurance currently; however, we have many options to utilize your insurance that are often successful with certain plans. Read more to see if you qualify for ketamine insurance coverage!

How To Acquire Ketamine IV Treatment Reimbursement 

  • Ketamine Infusions are often covered if you have out-of-network benefits within your insurance plan. Many insurance plans will apply the cost of your ketamine infusions towards your out-of-network deductible. Medicaid and Medicare are ineligible. After your deductible is reached, you are eligible to receive the approved cash reimbursement for your infusions. Our patient representative will work with your insurance company and submit all the paperwork on your behalf. At your initial psychiatry evaluation, we will determine if ketamine infusions are right for you. If you decide to proceed with treatment, you can contact our patient representative to determine what your insurance benefits will likely cover. Coverage depends on multiple factors and is completely dependent on your particular insurance plan.  
  • All payments to the clinic are done at the time of service and any cash reimbursement approved is sent directly to the patient by the insurance company or billing agency. 
  • If you are approved for coverage, this does not mean you will receive cash reimbursement for services. You must meet your deductible first, and then you will receive the approved cash reimbursement up to the amount you spent on services.  
  • If you are currently seeing our psychiatry team or therapy team it would be beneficial to submit superbills to your insurance company for these services. This will help you reach your out-of-network deductible. Once your out-of-network deductible is reached, the insurance company will reimburse you in the amount that was approved for your payments of services.  

What is a Superbill? How do I submit these? 

A superbill is an itemized receipt that is submitted to health insurance companies for reimbursement for medical expenses. The process works the smoothest if you remember to ask for and receive an electronic copy of your superbill at the end of your appointment. 

What must be Included on a Superbill? 

  • Patient and Provider Information: Provider’s first and last name, NPI number and/ or tax identification number, service office location, provider’s phone number, email address, referring provider first and last name (if applicable), referring provider’s NPI number (if applicable). In addition, the patient’s first and last name, address, phone number, and date of birth.  
  • Service Dates, Codes, Fees: Date of service, procedure code (CPT), diagnosis code (DX), modifiers (if applicable), units or minutes, and the fee charged. Failure to provide certain information can make you ineligible for ketamine insurance coverage.

What to ask your Insurance Company before submitting your Superbill 

  • Is pre-authorization required? 
  • Co-payment? 
  • Deductible? 
  • Today’s accumulation for the deductible? 
  • Co-insurance? 
  • Timely Filing 

What can I expect after submitting my Superbill? 

When a claim is received by insurance, most insurance companies will make a determination in two weeks. If reimbursement is due after a claim is processed, most insurances have a specific day of the week when checks are mailed. When the claim is processed accurately and applied to the deductible, no payment is forthcoming. 

Superbill Steps and Tricks 

  • Inform the staff that you would like all superbills from your psychiatry and or therapy appointments sent to you electronically. 
  • Call your insurance company and determine if you have out-of-network benefits. Ask what your out-of-network deductible is. If you have out-of-network benefits, get detailed steps to the most effective process to submit superbills for out-of-network services.  
  • Ensure that you mark/check the appropriate box for reimbursement. All cash reimbursements should be sent directly to you. If a check is sent and written to Ballen Medical and Wellness we will have to send it back to your insurance company to be reprocessed. This will delay you from receiving any cash reimbursement. We will not cash any checks or take any reimbursement funds from insurance companies.  
  • Submitting multiple bills with all the required documentation in bulk is often more efficient.  
  • Respond to any communication from the insurance company quickly.  
  • Be Persistent.  
  • Insurance companies tend to deny claims for any tiny mistake on paperwork during the submission process. Be thorough, read everything carefully.  
  • If your submission of superbills is denied, ask for the specific wording, code, or change that they would need to get coverage for the service. Be detailed, ask questions and demand detailed answers.  
  • Once approved, the process becomes much smoother. Stay determined! 

Are You a Candidate For The Reimbursement Process?

  1. Have you met your health insurance deductible for the year? Step 1 is to meet your insurance deductible for ketamine insurance coverage. This is done by submitting any out-of-network bills to your insurance company, this can include any medical service you receive that is considered out of network.  
  2. Do you have good out-of-network benefits? We are considered an out-of-network provider and many insurance plans have allowances that approve a portion of our services to be covered. 
  3. Do you have a PPO (preferred provider organization) insurance plan or an HMO (health maintenance organization) insurance plan? If you have a PPO plan, there is a higher likelihood of getting reimbursed. 
  4. Are you on Medicaid or Medicare? You may submit your superbills for psychiatry and therapy appointments. Our patient representative cannot submit ketamine infusions for Medicaid or Medicare.  
  5. Do you have FSA, HSA, or HRA? We accept these forms of payment. Know your benefits with these plans. Many companies have a yearly allowance and if you do not use your yearly benefit it does not roll over to the next year. You  

Here at Ballen Medical, we provide you with the tools necessary to live a better and happier life. As a result of Ketamine being a relatively new medical option, insurance companies are hesitant to provide full coverage. Our goal with this information is to provide our patients with the most accurate and up-to-date information with all of our treatment plans. Curious to learn more about the infusion process? Visit our Ketamine FAQs section. Have any more questions regarding Ketamine IV Therapy coverage? Contact us for more information!