Insurance Billing
Overview
Enhanced Edge is a variation of traditional talk therapy, using state-of-the-art and FDA cleared tech to measure, monitor, and document your mental health treatment progress. However, we still focus on Cognitive Behavioral Therapy (CBT) as the foundation for your treatment plans. That being said, in most cases, we bill your insurance using the same CPT billing codes as a normal therapy practice. All of our clinicians are licensed mental health professionals and are trained in Neuro/Biofeedback.
One of the exceptions to us billing your insurance is the Quantitative Electroencephalogram (QEEG). Enhanced Edge uses a cutting edge, FDA cleared tech called the “Dry QEEG” system for this process. The Dry QEEG is not only a cleaner and much more efficient reading, but it offers a plethora of information regarding all aspects of your brain physiological makeup. Our trained techs and clinicians decipher through your data to create your extensive report and treatment plan unique to you. This process takes a lot of time and the insurance company would not be able to cover the cost properly.
That being said, the $1500 cost of the QEEG is a self-pay responsibility. This includes your intake session, the QEEG reading session, all clinical hours to write and prepare your report/treatment plan, and a debriefing session with a trained provider reviewing the report and answering questions. As long as we are in-network with your insurance, all training sessions afterwards will be covered and billed to your insurance. You may still be responsible for Co-Pays or any items moved to patient responsibility by your insurance.
Insurance billing
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Enhanced Edge is currently in-network with:
Highmark BlueCross BlueShield of Delaware
We are actively pursuing credentialing with other major insurances and will update the website once finalized.
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As a practice, Enhanced Edge will bill the following code(s) to your insurance (as necessary):
90791 - Psychiatric Diagnostic Evaluation
90837 - Individual Therapy Session (60 min)
90834 - Individual Therapy Session (45 min)
90832 - Individual Therapy Session (30 min)
90901 - Biofeedback Training
90785 - Interactive Complexity
99211 - For Health Evaluation & Biological Documentation (vitals)
96156 - Behavior Health Assessment
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The following procedures will be a self-pay service:
Brain Map Conductance, Report, & Review (required for training sessions)
Alpha-Stim Purchase (optional & you may be reimbursed by your insurance)
Any court fees that arise from Enhanced Edge providers having to get involved in court cases
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It is the client responsibility to know the following items required by Enhanced Edge or your insurance provider. This list is not extensive. Please contact your insurance provider for more information.
If you see an additional provider outside of Enhanced Edge for additional talk therapy, you cannot see both providers in the same day.
Your insurance will only pay one of the claims and you may be held responsible to cover the cost of the other
If you have a deductible, copay, or coinsurance: you may be held responsible for some or all of the treatment cost. This will be due at time of service.
It is YOUR responsibility to know your insurance eligibility, verification, and benefits. Enhanced Edge bills your insurance as a courtesy, but ultimately your insurance decides if they pay for the service or not. Any denied claims that are not able to be remedied will fall to patient responsibility
Insurance Billing FAQ
How do I know if this is covered by my Insurance?
If your insurance covers Behavioral Health Services (Psychotherapy), then they will cover our service (as long as we are in-network with them).
Enhanced Edge treatment modalities are Psychotherapy based and is treated just like other outpatient therapy offices. The Neurofeedback is treated as a courtesy procedure provided by our practice in order to provide higher quality client care and documentation.
Your insurance will not cover the QEEG Brainmap.
Will my insurance cover services if I see an additional mental health provider?
Yes, there is no limit to how many mental health providers you see for Psychotherapy services. HOWEVER, since both practices are performing a psychotherapy service and are billing as such, YOU MAY NOT SEE BOTH PROVIDERS ON THE SAME DAY. Your insurance will only pay one of the claims and you may be held responsible for the other.
It is your responsibility to know and abide by this. We have no way of seeing the codes were already billed for the day by other practices (including Mental Edge).
Is there a copay for these services?
Yes, normal copay fees apply. Enhanced Edge is performing an outpatient Psychotherapy service and will be billed as such. In order to maintain insurance contracts, Enhanced Edge is REQUIRED to collect copay fees at time of service.
Are there any services not covered by insurance?
Yes, the Quantitative Electroencephalogram (QEEG) Brainmap is not covered by insurance. A few other optional procedure / device purchasing options are not directly covered by insurance. See above for more information.
What if the insurance claim gets denied?
Insurance billing is an extremely particular and complicated process. There are many factors that play into the approved payment of claims, and result in a lot of denied claims. Insurance companies can deny and take back charges up to a year after payment.
The Enhanced Edge team will do as much as we possibly can to remedy and re-bill claims at no-cost, but sometimes denial remedies are out of our control. This may results in claim(s) being moved to patient responsibility meaning you will be charged for any of these denied claims at the rate expressed in our fee schedule.
Where can I get more information regarding my Insurance billing?
All insurance plans are different and their coverage & terms vary individually. The only way to get all of the information specific to you is to call your insurance provider.
Enhanced Edge will do our due diligence to ensure you do not encouter unforeseen charges. However, ultimately it is the patient's responsibility to know and abide by their insurance terms.