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INSURANCE OUT-OF-NETWORK GUIDE 

Disclaimer: 

Gulf Coast Family Services and Monica J. Peak, LPC, Ed.S, NCC are out-of-network with ALL insurance companies. This guide is designed to help you contact your insurance company to verify your out-of-network benefits. We are not responsible for the information obtained through the use of this guide.

Payment:

Payment is due at each scheduled appointment. Clients are required to keep an active credit card on file, which will be charged for services rendered on the same day. All credit cards on file can be edited directly from the client portal at https://monicapeak.clientsecure.me. 

We also offer CareCredit Financing: https://www.carecredit.com/go/344SVS/

All clients will receive a Superbill, specifically designed to submit to the insurance company for reimbursement, as well as an invoice for payment of all services provided. The PDF documents are available for viewing or downloading in the client portal and can be submitted to the insurance company for reimbursement. 

It is the client's responsibility to handle any desired reimbursement submission. Alternatively, consider using the online service provided by Thrizer for assistance with filing your claim (https://www.thrizer.com/help-center/superbill-upload).

How to check your out-of-network coverage and possible benefits:

• Plan for 15 to 30 minutes of your time to call your insurance company.
• Make sure you have the following information ready before your call:
  • Insurance card
  • Name, date of birth, address, phone number, and social security number of the insurance holder or the person for whom the services are to be provided
  • Pen and paper or a notepad

• Questions to ask:
  • Are there out-of-network benefits for this policy?
  • Do I have a mental or Behavioral Health policy with out-of-network benefits?
  • What are the requirements to use out-of-network benefits?
  • Is prior authorization required?
  • Is a referral required from my primary care physician?
  • Do I have an out-of-network deductible?
    • If yes:
      • What is my out-of-network deductible?
      • How much of my out-of-network deductible has been met?
      • What is the start date of the calendar year my out-of-network policy is based on?
    • In addition, ask the representative if your policy covers the services listed in the table below.
      • How much is the insurance company's “usual and customary fee?” 
      • What percentage do they cover after the deductible is met?
  • Is there a session limit?
    •  If yes:
      • What is the session limit?
      • How many sessions do I have left?
  • What percentage of services is covered, or what is my coinsurance?
  • At the end of the call, make sure you have:
    • Date and time you called
    • The representative's name
    • A reference number for the call

Information that will be provided on your Superbill:

• Provider’s name
• Provider’s NPI
• Provider’s license number
• Federal tax ID number
• DSM-5 and ICD-10 diagnosis codes
• CPT or procedure codes 

Print this page and use the next section to take notes during your phone call to the insurance company.

Out-of-Network Insurance Information 

Insurance Name:  

Member ID:  

Group Number:  

Date/time of call:  

Representative’s name:  

Reference number for the call: 

* See informed consent for fees regarding court and subpoenas