Client Portal

Out-of-Network Insurance Verification Form

Schedule a Free Consult

The best way to find out if this approach is for you is to schedule a complimentary consultation. All counseling consults are 20-30 minutes long. Depending on availability, this consult may be held over the phone, via video, or in-person.

Match me with a Therapist

Please call the 800 number on your insurance card and complete this form with a customer service representative via telephone. It is important that you understand your insurance coverage prior to starting services at HWP.

Client Name

  • DOB:
  • SSN:  

Insured Name:

  • DOB:
  • SSN:

Insurance Company:

  • Insurance Phone Number:
  • Mental Health Insurance (may be different than health insurance):
  • Claims Address:
  • Client Insurance ID#:
  • Group #:

Mental Health Services

1) “Do I have mental/behavioral health coverage?” □ YES □ NO

If YES, continue.

2) “Do I have Out-of-Network benefits?” □ YES □ NO

If YES, continue.

3) “Do I have an Out-of-Network deductible?” □ YES □ NO

If YES, “What is my out-of-network deductible?”

“How much of my out-of-network deductible has been met?”

4) “Please verify that the following services are covered under my policy? If YES, what percentage?”

In-Person Sessions:

  • Individual Therapy, 30 minutes (CPT Code 90832): □ YES □ NO _____%
  • Individual Therapy, 45 minutes (CPT Code 90834): □ YES □ NO _____%
  • Individual Therapy, 60 minutes (CPT Code 90837): □ YES □ NO _____%
  • Family Therapy, without patient present (CPT CODE 90846): □ YES □ NO _____%
  • Couples, Marriage, & Family Therapy, with patient present (CPT CODE 90847): □ YES □ NO _____%
  • Group Therapy (CPT Code 90853): □ YES □ NO _____%
  • Psychiatric Diagnostic Evaluation (CPT Code 90792): □ YES □ NO _____%
  • Level 3 Visit – Psych. Followup (CPT Code 99213): □ YES □ NO _____%
  • Level 4 Visit – Psych. Followup (CPT Code 99214): □ YES □ NO _____%

Video Sessions:

  • Individual Therapy, 30 minutes (CPT Code 90832-95): □ YES □ NO _____%
  • Individual Therapy, 45 minutes (CPT Code 90834-95): □ YES □ NO _____%
  • Individual Therapy, 60 minutes (CPT Code 90837-95): □ YES □ NO _____%
  • Family Therapy, without patient present (CPT CODE 90846-95): □ YES □ NO _____%
  • Couples, Marriage, & Family Therapy, with patient present (CPT CODE 90847-95): □ YES □ NO _____%
  • Group Therapy (CPT Code 90853-95): □ YES □ NO _____%
  • Psychiatric Diagnostic Evaluation (CPT Code 90792-95): □ YES □ NO _____%
  • Level 3 Visit – Psych. Followup (CPT Code 99213-95): □ YES □ NO _____%
  • Level 4 Visit – Psych. Followup (CPT Code 99214-95): □ YES □ NO _____%

5) “Do I need an authorization to receive any of these services?” □ YES □ NO

If YES, “What is my authorization number?”
“How many sessions are authorized?”

6) “What forms do I need to submit for reimbursement?”

7) “Do you require the providers signature on the superbill?”

8) “What is the most efficient way to submit these forms?”

Note: HWP is not responsible for coverage or reimbursement. Please be advised that time spent performing insurance-related requests exceeding 15 minutes is not included in the session rate and will be billed at your provider’s hourly rate. Coaching sessions, wellness services, workshops and recommended testing through third-party companies (e.g. neuroendocrine and pharmacogenetic testing) are not eligible for insurance reimbursement.

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Frequently Asked Questions

How do I schedule an appointment?

If you are a new client, you may schedule your complimentary consultation or your initial appointment by visiting the contact page and filling out the short form or outreaching directly to your desired provider by calling (470) 231-5355.

If you are an existing client, please outreach to your provider directly either by telephone, email, or via the client portal secure messaging system.

Do you accept my insurance?

HWP does not accept insurance. Managed care companies were created to “manage” and contain escalating health care costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care professionals provide or your quality of life. HWP is solution-focused on quality of life and personal goals.

What is your cancellation policy?

If you need to cancel or change your appointment, we ask you to inform your provider at least 24 hours in advance of your scheduled session start time. Your full session fee will be charged for missed appointments and cancellations received less than 24 hours in advance.

What forms of payment do you accept?

Cash, credit cards, and health savings (HSA) or flex spending account (FSA) cards that have a major credit card logo on it are all accepted forms of payment.