Blue Cross Blue Shield of North Carolina

Effective June 7, 2006 Dr. Whiteside participates in the BCBS of NC provider network. Because BCBS offers a number of plans with different benefits it is still necessary for you to review your particular plan's policy to determine what deductible, co-payment, co-insurance, authorization requirements, and exclusion of services apply.

In order for insurance company advisors to give you accurate information it is usually helpful for you to explain that you will be seeing an in-network psychologist for mental health services, typically billed as "CPT-2006 procedures 90801 (Initial or diagnostic intake session) and 90806 (individual psychotherapy)."

Some services may not be covered by your policy or may require pre-authorization so it is best to ask in advance. If your'e interested in marriage counseling or psychological testing, for example, be sure to ask them about coverage for CPT-2006 procedure codes 90847 and 96100.

Other Insurance Coverage

At this time Dr Whiteside does not participate on any other managed care panels. Many insurance companies provide for "out-of-network" benefits, with a slightly higher co-payment typically required. You will need to pay Dr. Whiteside the full fee and apply to your insurer for reimbursement. Please check with you insurer to find out what reimbursement, if any, may be provided by your insurer for our services. While we can provide you with printed claims forms ready to file, we require payment in fulll at the time of service.

Insurance and Mental Health Benefits Participation, by Plan

Please note that this list was last updated March 19, 2008. It is based on information submitted to Triangle CAAR by individual providers and has not been verified by your insurance company. Before relying on this information you should call your company or check their web site lists to confirm current participation. Please note that medical insurance companies sell many varieties of plans to employers, agencies, and individuals. Additionally, some medical insurance companies “outsource” or “carve out” management of mental health benefits to other companies. Just because a psychologist participates on one insurance plan doesn’t necessarily mean she or he participates in all plans. Typically HMO plans require that you use an in-network provider while other types of plans, such as a PPO, may provide coverage to non-participating psychologists though with a higher co-payment and possibly a deductible. Occasionally benefits managers will agree to “single case” contracts if a subscriber has difficulty locating an in-network provider in their area qualified to provide a medically necessary service. Some plans require pre-authorization, may exclude treatment of pre-existing conditions, and limit the number of sessions or expenditure in a specified time period.

Determine what company manages your mental health benefits, and obtain a listing of in-network providers by calling customer service or accessing their web site. Mental health providers may include psychiatrists, psychologists, social workers, and counselors. Ask about possible pre-authorizations needed, deductibles, co-payments, number of mental health visits allowed per benefit period, and any other limitations with your benefits (e.g., are some diagnoses covered while others are not). CPT insurance codes commonly used for mental health services, which you could inquire about coverage with your insurance representative, include 90801 for initial diagnostic interview, 96101 for psychological testing, 90806 for individual therapy, and 90847 for family therapy.