Fees & Insurance


 

Please call 510.852.9772 to discuss fees for specific services. Rates are competitive for the Bay Area. Dr. Zoffness is not currently on any insurance panels, but can provide a super bill at the end of the month to submit to your insurance company. Check with your insurance to determine what percent of CBT they will cover.

 

GETTING REIMBURSED BY INSURANCE FOR CBT:

 

1. If your child's doctor/neurologist has recommended CBT, make sure to get a written prescription. When you call your insurance, inform them that CBT has been "prescribed" by your child's medical doctor, and be ready to provide a copy of the prescription if they request it.

 

2. If CBT is "medically necessary," you should use this language with your insurance. If CBT has been recommended or prescribed by a medical doctor, it may be considered medically necessary, especially if your child has missed a significant amount of school or his/her functioning is impaired. It is more likely that an insurance company will cover a service if it is medically necessary. 

 

3. If your child has had pain or health issues for 3 or more months, this may be considered "chronic pain." This is also important information and may affect the likelihood that your claim is reimbursed. If it applies, use this term when you speak with your insurance.

 

4. Always get the name of the person with whom you are speaking and note the date.

 

5. If your insurance company denies you coverage for CBT, ask for it in writing

 

6. It may be possible to set up a Direct Pay Agreement. With a Direct Pay Agreement, you pay your provider directly and your insurance company then reimburses you. This Agreement enables you to get reimbursed by your insurance company when you use an out-of-network provider as if the provider is in-network. Typically, your provider helps set this up.

 

7. As a reason not to reimburse out-of-network services, insurance companies may say they have "hundreds" of providers who do this exact same work & have the same training. As the service recipient, YOU HAVE THE RIGHT to specify what you want in a provider: e.g.: male/female, level of training (Masters vs PhD), type of training (CBT vs psychodynamic, etc), specific expertise (child/teen, chronic pain), and availability (after school and evenings vs mornings, etc). If you are told that there are many providers in your area who have all of these qualifications, get the names of these providers, call them, and call back your insurance company when you find discrepancies. Insurance companies should not send you to providers who cannot effectively or appropriately help your child.