Insurance and Mental Health Benefits Participation, by Plan

fillerPlease note that this list was last updated February 10th, 2015. It is based on information submitted to Triangle CAAR by individual providers and has not been verified by your insurance company. Before relying on this information you should call your company or check their web site lists to confirm current participation. Please note that medical insurance companies sell many varieties of plans to employers, agencies, and individuals. Additionally, some medical insurance companies “outsource” or “carve out” management of mental health benefits to other companies. Just because a psychologist participates on one insurance plan doesn’t necessarily mean she or he participates in all plans. Typically HMO plans require that you use an in-network provider while other types of plans, such as a PPO, may provide coverage to non-participating psychologists though with a higher co-payment and possibly a deductible. Occasionally benefits managers will agree to “single case” contracts if a subscriber has difficulty locating an in-network provider in their area qualified to provide a medically necessary service. Some plans require pre-authorization, may exclude treatment of pre-existing conditions, and limit the number of sessions or expenditure in a specified time period.

Blue Cross Blue Shield of North Carolina

  • Susan McClure, Ph.D.
  • Cheryl Stallings, Ph.D.
  • Jackie Veloz-Jefferson, Ed.S., LPS

NC Health Choice

  • Jackie Veloz-Jefferson, Ed.S., LPS

Medicaid

  • Jackie Veloz-Jefferson, Ed.S., LPS

Medicare

  • Jackie Veloz-Jefferson, Ed.S., LPS

IPRS

  • Jackie Veloz-Jefferson, Ed.S., LPS

NC State Health Plan

  • Susan McClure, Ph.D.
  • Jackelin Veloz-Jefferson, Ed.S., LPS
  • Reid Whiteside, Ph.D.

Determine what company manages your mental health benefits, and obtain a listing of in-network providers by calling customer service or accessing their web site. Mental health providers may include psychiatrists, psychologists, social workers, and counselors. Ask about possible pre-authorizations needed, deductibles, co-payments, number of mental health visits allowed per benefit period, and any other limitations with your benefits (e.g., are some diagnoses covered while others are not). CPT insurance codes commonly used for mental health services, which you could inquire about coverage with your insurance representative, include 90791 for initial diagnostic interview, 96101, 96102, 96103, 96118, 96119, or 96120 for psychological testing, 90834 or 90837 for individual therapy, and 90847 for family therapy.

 


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