RE: Insurance Reimbursement Center for Brain Training Guidelines.
At our Center, we’re not on insurance panels, and we don’t file the insurance for you. We can generate an insurance form that you can file. It’s filled with insurance codes for your sessions plus the other information required on an insurance form, including the name of the insurance company and address. You can simply mail it in to the company. Our clients pay the Center with credit cards or checks. Sessions are often billed as biofeedback insurance code 90901 (though other codes are used on occasion ). Sometimes insurance companies cover the codes and reimburse. Insurance companies are also very good at denying reimbursement. That’s not unique to neurofeedback; we know MD’s denied reimbursement at times for necessary medical codes.
It’s usually easy to get an MD to prescribe biofeedback (same as neurofeedback). That at least increases the odds of reimbursement. Some clients have been covered with United Health Care and Cigna using biofeedback. That doesn’t mean everyone is approved. Most insurance companies are good at saying no, at least in the first submittal. We don’t have good information on other companies. Florida Blue Cross doesn’t tend to reimburse the 90901 code. Other state Blue Cross plans sometimes do. It’s been reported that patients who are aggressive at appealing may increase the chances of reimbursement. Insurance policies vary, including which diagnosis code for which they will reimburse. We aren’t set up for filing insurance. We’ve heard of clients who contested claims by stating that the insurance companies are forcing the use of medications with significant side effects while denying research-based treatments (such as neurofeedback) that has no side effects. We don’t know how successful this technique is.
The Center has an insurance questionnaire available that gives questions to ask your insurance company to help assist us in getting the best codes listed for your company. If you haven’t yet clicked to get the form, click here.
The fact sheet with questions for your insurance company helps us increase the odds that your insurance form will be accepted. We like to get a doctor’s prescription for biofeedback, because there’s a place on the insurance form for it. It maximizes the chance that you can be reimbursed. However, it’s not required you have a prescription, and some insurance companies won’t care if you have a doctor’s prescription or not. We’ve included several codes but the main code that we typically use to file is 90901 for biofeedback. Many insurance companies have a policy that disallows biofeedback code for some diagnostic codes. For example, ADHD reimbursement is often rejected though there’s good published research on its effectiveness. It’s a valid code and should be covered. But there’s little pressure on insurance companies to change. Other codes such as sleep problems or migraines may be more easily covered, though that can vary immensely. It’s unfortunate that insurance companies seem to play an adversary role with their customers.
Learning vs. Long-Term Medications
Unlike medications, neurofeedback is learning. When you succeed at training the brain, which can take a while, you STOP the training. You don’t continue to need it if you function better. With medications, often you are looking at taking them for the rest of your life. They don’t teach you anything. So when you pay for neurofeedback sessions, it’s usually not for your whole life. When the brain is tuned, this process may reduce the use of medications – which may reduce the costs of medication overall, of side effects to medications, of doctors visits, and of the many accommodations made to deal with the problems. Often medications leave symptoms that can be improved when the brain is tuned up.
Feel free to contact us if you have more questions.