Will My Insurance Cover Services Provided by Children’s Health Council?

HOW TO FIND OUT

To estimate general coverage before seeing a Children’s Health Council (CHC) specialist, contact your insurance company.  For more specific information about coverage, contact your insurance company after you meet with a CHC specialist and provide CPT codes.*

  1. When you contact your insurance company, provide CHC’s tax ID number:  94-1312311.
  2. Ask these questions to estimate coverage:
  • Do you require a pre-authorization for out-of-network services?
  • Do the services provided need to be completed by a licensed therapist?
  • What does my plan deem as customary and reasonable rates for recommended services?
  • What is my plan’s deductible, and how much have I already met?
  • What is my plan’s coverage for mental health services, occupational therapy services, and speech-language services?  (Educational services are not covered.) What is the coverage for testing services?  What is covered for therapy services? (In-home or at-school visits are not covered.)

NOTE: 

CHC does not bill insurance companies on your behalf and is not a preferred or in-network provider.  You are responsible for your bill and for submitting and receiving claim forms and reimbursement from your insurance company.  

Know Your Rights: 

Legislation mandates coverage for services under the category of mental health.  Limitations based on your plan and your employer are specified in the legislation.  For more information, see the 1996 Mental Health Parity Act and the 2008 Mental Health Parity and Addiction Equity Act.  

*CPT Codes: 

Your insurance company may ask which CPT codes will be used.  CPT codes are determined by the actual service provided.  After your first appointment, the specialist can provide you with CPT codes based on recommended services.  Note:  CPT codes cannot be chosen or changed to meet your plan’s coverage.