Fees & Insurance

-For Patients: Get reimbursed for CBT-

Dr. Zoffness is not currently on any insurance panels but provides superbills for submission to insurance companies. For greater reimbursement success, follow these tips: 


1. If you/your child's physician has recommended CBT, get a written prescription. When you call your insurance, inform them that CBT has been "prescribed" by your child's medical doctor and provide a copy of the prescription.


2. If CBT is "medically necessary," use this language with your insurance. If CBT has been recommended or prescribed by a physician, it may be considered medically necessary, especially if you/your child has missed a significant amount of school or his/her functioning is impaired. An insurance company is more likely to cover a service if it's medically necessary. 


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


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 this in writing. Ask to speak with a manager and work your way up if you believe your claim is valid.


6. Tell your insurance if a particular therapist: a) was specifically recommended by your physician, and b) works closely with your medical team. This collaborative relationship makes your provider unique, and is a reason that insurance companies may decide to reimburse treatment provided by an out-of-network provider.


7. As a reason not to reimburse out-of-network services, insurance companies often say they have "hundreds of CBT therapists in-network." As the service recipient, you are permitted to specify what you want in a provider: e.g.: male/female, specific expertise (child/teen, chronic pain), someone who works closely with your physicians, etc. If you're 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 you/your child.  


8. Money money money: It's often helpful to explain to the insurance company that CBT has the potential to ultimately save them money. If therapy is effective, insurance won't have to reimburse additional medical visits, medical procedures, and other interventions. 


9. Prevent transmission of money stress to your child. Children and teens have a million sources of stress: school, peers, social media, fake news, real news... the last thing they need to worry about are adult stressors. Children with pain or illness often feel stressed about money, specifically the cost of their own medical bills. So while it's important to teach your child about money, limit "money talk" about treatment costs to adults. Otherwise, this stress is transmitted to children, who then worry and feel guilty about attending therapy or medical appointments. Teens shouldn't have to take on adult stress... it's hard enough just surviving high school!