Frequently Asked Insurance Questions                   

1. Can insurance be used for the social skills groups?

Answer:  As usual, "it depends" - on a number issues.  The following must be satisfied for insurance to work:

  • Your child must have a diagnosis.  A diagnosis could be given by a physician, clinical psychologist, neurologist, psychiatric nurse, psychiatrist, clinical social worker, …
  • Your insurance must have Out of Network Benefits
  • Your deductible must have been reached
  • Your insurance takes either a Licensed Marriage and Family Therapist or a Board Certified Behavior Analyst.  

2. Do you bill my insurance company directly?

Answer:  No.  PositiveFamilyBehavior, LLC provides you with an invoice that is to be paid by the family.  The invoice has all the necessary information on it for the family to submit it to the insurance company.  The insurance company then sends some percentage of reimbursement back to the family.  Occasionally the insurance company will send such payment to PositiveFamilyBehavior, LLC which will either be applied to any balance or submitted to the family directly.  A sliding scale is provided for those who qualify.   

3. How do I check to see if any services will be covered by my insurance company?

Answer: The best thing to do is call the insurance company in advance.  You will need to have a diagnosis for your child, though if any services were covered in the past the insurance company will already have such information.  You then provide them with my license number and certification number.  Finally, you provide them with either a CPT Code to see if it would be covered, or you ask the insurance company which alternative CPT code would be covered.  The CPT code is the number that references the type of service provided.  The  reimbursement rate is tied to the CPT code.

Todd T. Kellogg, LMFT, BCBA

Licensed Marriage and Family Therapist

Board Certified and Licensed Behavior Analyst

CT (LMFT) License #: 001082 / BCBA Cert. #: 1-10-7882 / CT LBA #: 593

NPI#: 1003092164

Possible CPT Codes that could be offered:

Individual psychotherapy with client and/or a family member:

 - 90832 (30 minutes)

 - 90834 (45 minutes) *The most common code used.

 - 90837 (60 minutes) **May need prior authorization

Group psychotherapy (would be used for social skills group):

 - 90853

© PositveFamilyBehavior, LLC 2012-2020     © Todd T. Kellogg, LMFT, BCBA 2012-2020