Insurance
Plans, Billing Codes, and Authorizations
I am credentialed with most Sanford and Avera health plans. As of July 5, 2024, I am no longer participating with Wellmark, Anthem, or BlueCross plans.
​
I am a South Dakota Medicaid and Medicare provider, and I am a Federal Medicare provider. Medicaid rules prohibit me from credentialing with Medicaid in other states or billing as an out-of-network provider for Medicaid in other states.
​
I am not in-network with any other insurances. If your insurance company tells you otherwise, they are mistaken. Some insurance companies have listed me as in-network even though I did not apply or sign a contract with them. Because my practice is just me, I have to be selective with which companies I credential with in order to run my business. I base these decisions on the admin time required to bill each company as well as the reimbursement rates. If I cannot sustainably accept the offered contract, I do not credential with that company.
​
For those seeking a psychological assessment and need a more affordable option, please read this.
​
In addition to these insurances, I provide EAP therapy services through Lyra Health, Modern Health, and Spring Health. Check with your employer regarding your benefits and coverage.
​
If I am not in-network with your insurance, I can provide you with a superbill that allows you to request reimbursement from your insurance company after you have paid for the services directly. For some plans, I am able to bill as an out-of-network provider. This depends on what your plan allows.​
​
Under the ACA, health insurance plans are required to cover mental health. However, I recommend calling your insurance company at the customer support number on the back of your card to get information about coverage, deductibles, co-pays, and prior authorizations.
​
Since most of my sessions are conducted via telehealth, all billing codes also include a telehealth specifier. Ask your insurance provider if telehealth sessions are covered under your policy.
​
Please be aware that insurance companies reserve the right to deny coverage even if they have told you that a service is covered. I recommend getting the name of the representative you spoke with, an identification number for the call, and note the date and time of the call.
​
Please also be aware that, if your insurance denies coverage or does not cover the full cost of services, you are responsible for your balance. If this occurs, I can work with you on setting up a payment plan that fits your budget.
​
I use the following billing codes in my practice:
90791: Diagnostic interview/intake. This code is used to bill your first session or a new intake session if you have not been seen for more than six months.
90837: One-hour appointment, which is any appointment lasting longer than 53 minutes.
90834: 45-minute appointment, which is an appointment lasting 38 minutes to 52 minutes.
90832: Half-hour appointment, which is an appointment lasting 16 minutes to 37 minutes.
90839: Crisis session, which is an appointment of up to 60 minutes for crisis intervention.
96136/96137: Psychological testing administration, measured in 30 minute increments. Administration lasting 16-45 minutes is billed as one unit. The first code is for the first half hour of testing, with additional units billed as the second code.
96130/96131: Psychological testing interpretation and report writing, measured in 60 minute increments. The first hour is billed as the first billing code, with additional units billed as the second code.
​
If your insurance changes, or you lose coverage, please let me know right away so that you are not surprised with a bill. If you have a deductible plan, note that the deductible typically starts over on January 1, so your bill might increase at this time.
