Patient Guide to Insurance Verification
Understanding your insurance coverage can be challenging, but our guide is designed to make this process smoother and less intimidating. While Radical Healing Collaborative (RHC) may assist in verifying coverage, we cannot guarantee payment from your insurance company.
Any charges denied by your insurance will be billed to you, as per our group policy practices. We recommend calling your insurance company’s customer service number, found on the back of your insurance card, to verify your coverage before your first visit. Be prepared to provide your Member/Subscriber ID Number, date of birth, and/or Social Security number.
In-Network Coverage
For Primary Care, Psychiatric Medication Management & Mental Health Therapy, RHC is an in-network provider with BCBS (all plans except Blue Local & Blue Home-UNC Health Alliance), United/Optum/Oscar, Aetna, Cigna, Tricare, Medcost, Ambetter and most Medicaid plans including: Healthy Blue, United Community Plan, Wellcare, Amerihealth, Ambetter, Vaya Health, Carolina Complete Health, Partners, Trillium (Primary Care Only), Alliance.
For Physical Therapy, RHC is an in-network provider with BCBS (all plans except Blue Local & Blue Home – UNC Health Alliance), United/Optum/Oscar, Aetna, Cigna. Physical Therapy is NOT currently in network with Medicaid or Ambetter.
Please visit each department’s website to see the most up to date insurance plans including each Medicaid plan we are currently in network with.
Please note we will soon be in network with Medicare.
Calling Your Insurance Company
When speaking with an insurance representative, consider asking these questions to clarify your coverage:
- Is David Young Oh (NPI: 1750729489) an in-network provider for my plan?
- Does my plan cover outpatient psychotherapy, specifically CPT code 90837 (Psychotherapy – individual, 60 min.)? For mediciation management services, verify that you plan covers CPT codes 99205 (Office Visit – New Patient), 99214 (Office Visit – Established Patient), and 90833 (Office Visit, Established Patient – Psychoeducation)
- What is my deductible, and how much has been met so far?
- Do I have a copayment or co-insurance for each visit, and what is the coverage percentage?
- How many therapy sessions are covered per year, and when does my policy year renew?
- Is there coverage for Telehealth services?
- Are there any restrictions or limitations to my coverage?
Record the answers and the reference number of your call for future reference. If you have questions about your coverage after speaking with your insurance company, contact us at billing@radicalhealing.us for assistance.
Note on Multiple Insurance Coverage
If you have multiple insurance plans (e.g., primary subscriber on one and dependent on another), we must bill the policy where you are the primary subscriber.
Glossary of Commonly Used Insurance Terms
- Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage of the allowed amount for the service.
- Copayment: A fixed amount you pay for a covered health service, usually when you receive the service.
- Current Procedural Terminology (CPT): Codes used to describe medical, surgical, and diagnostic services.
- Deductible: The amount you pay for covered health services before your insurance plan starts to pay.
- In-network: Providers or healthcare facilities part of your health plan’s network of providers.
- National Provider Identifier (NPI): A unique identification number for covered health care providers.
- Out-of-network: Providers or healthcare facilities not part of your health plan’s network.
- Out-of-pocket costs: Costs for medical care that aren’t reimbursed by insurance.
- Out-of-pocket limit: The most you have to pay for covered services in a plan year.
- PPO (Preferred Provider Organization): A type of health insurance plan that offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to plan members at a certain rate.
Navigating insurance can be complex, but understanding these terms and knowing the right questions to ask can empower you to make informed decisions about your healthcare. Remember, we’re here to assist you through this process. If you have any further questions or need clarification, don’t hesitate to reach out to us at Radical Healing Collaborative.