Dear Blue Cross/Blue Shield PPO Prospective Client

To ensure seamless payment from Blue Cross/Blue Shield (BC/BS), we recommend that you call your insurance company prior to your first session at The Family Institute. Please ask for the following information, and bring the information to your first appointment.

1. Not all BC/BS plans are created equal. Call the number on the back of your insurance card and make sure you are covered by a Blue Cross PPO. If you are in a Blue Cross HMO, you will not be covered by your insurance at The Family Institute.

2. If you are covered by a Blue Cross PPO, you must know if your mental health/counseling coverage is managed by another company outside of BC/BS. If your insurance is managed by BC/BS skip to question 3. If not, please ask for the following information.

a. Does the provider (your therapist at The Family Institute) have to be in-network for the managed care company as well as for Blue Cross? If they do, then your insurance will not cover your services at The Family Institute.

b. Can you be seen for a first session without authorization from your outside managed care company? If No, you must get authorization or your insurance will not cover your services.

c. If you can be seen without authorization, how many sessions can you have before you need an authorization and/or treatment plan sent to the managed care company?

3. If you are covered by a Blue Cross PPO and your mental health/counseling benefits are not managed by another company and you do not have any pre-authorization needs, then you can be seen and be covered by your insurance. However, per Blue Cross, verification of coverage does not guarantee benefits, and anything not covered once the claims are processed will be your responsibility to pay. The following information is necessary to know the amount you will have to pay to The Family Institute.

a. Is there an annual deductible for mental health coverage separate from your medical deductible that needs to be met first?

b. How much of your mental health deductible have you met this year?

d. What is your co-payment for each session once the deductible is met?

e. Is there a limit to the number of psychotherapy sessions allowed annually by your policy?

f. Is there a limit to the amount of dollars they will pay each year?

g.. Is there a Lifetime limit on your policy?  If so, how much have you met to date?

Download the BC/BS Claim Submission form above.  Please fill it out and bring it to your first appointment.

The Family Institute is interested in keeping your payments appropriate to your benefits, but until these issues are verified by you, The Family Institute will charge you a deposit on each service. Any overpayment discovered when these issues are verified will be refunded or applied to future appointments at your request. If you need help with this information or the following form, you may contact the Billing Office at The Family Institute. 847-733-4300 ext. 600.