Important Information for BCBS HMO Members

Before we schedule your first appointment: HMO plans work differently than other insurance plans, and we need your help to make sure your coverage will work the way you're hoping.

Blue Cross Blue Shield (BCBS) has many different HMO plan versions, and unfortunately, we can't always verify whether Discovery Counseling Austin is in-network for your specific plan. This is especially true for out-of-state BCBS HMO plans.

Your Two Options (Pick One!)

Option 1: Verify Your Coverage First (Recommended - Takes 10 Minutes)

Call your insurance or check your member portal/app before scheduling.

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Best for: People who want certainty before starting therapy

Option 2: Start Therapy Now, Sort It Out Later (The Risk Option)

Schedule and start therapy without verifying. We'll bill your insurance and see what happens.

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Best for: People comfortable with potential out-of-pocket costs if insurance doesn't cover it

Option 1: How to Verify Your Coverage (We Recommend This!)

You have three ways to check if we're in-network for your specific HMO plan:

Method 1: Check Your Insurance App or Website

  1. Log into your BCBS member portal or app
  2. Go to "Find a Provider" or "Search Network"
  3. Search for Discovery Counseling Austin OR search by our Group NPI: 1144733270
  4. Look for your specific therapist's name (Keisha or Kiley can provide their individual NPI if needed)
  5. Make sure it shows "In-Network" for your plan

Method 2: Call Member Services

Call the number on the back of your insurance card and ask:

  1. "Is Discovery Counseling Austin (Group NPI 1144733270) in-network for my HMO plan for outpatient mental health services?"
  2. "Does my plan require a referral from my PCP to see a therapist?" (Most mental health HMO plans don't, but some do)
  3. "What is my copay or coinsurance for outpatient mental health visits?"
  4. "Do I have a deductible I need to meet first?"
  5. "Are there any limitations on the number of therapy sessions covered per year?"

Write down the representative's name, date, and reference number for your records.

Method 3: Ask Keisha or Kiley for Your Therapist's NPI

If you're having trouble finding us by practice name, reply to your intake email and ask for your specific therapist's NPI number. You can search for them individually in your insurance portal.

Our Information for Your Search:

Practice Name: Discovery Counseling Austin
Tax ID: 82-2811871
Group NPI: 1144733270

Once you've confirmed coverage, reach out to us and we'll get you scheduled!

Option 2: Start Therapy and See What Happens

You can choose to schedule and start therapy without verifying coverage first. We'll bill your first session or two and see what your insurance says.

Here's what you're agreeing to if you choose this option:

  • If your insurance denies the claim because we're not in-network for your specific HMO plan, you are responsible for paying the full contracted rate (typically $100-130 per session)
  • If your plan required a referral that you didn't obtain, you are responsible for the full session cost
  • If your insurance approves coverage, great! You'll pay whatever your plan's copay or coinsurance is

This option works best for people who:

  • Are comfortable with financial uncertainty
  • Can afford to pay out-of-pocket if insurance doesn't cover it
  • Want to start therapy quickly and sort out the details later

If Your Plan Requires a Referral (Some Do, Most Don't)

Most BCBS HMO plans do NOT require referrals for mental health services, but some do. If you verified your coverage and your insurance told you that you need a referral, here's how to get one:

  1. Call your Primary Care Physician's office
  2. Request a referral for outpatient mental health services at Discovery Counseling Austin
  3. Provide your PCP's office with our information:
    • Practice Name: Discovery Counseling Austin
    • Tax ID: 82-2811871
    • Group NPI: 1144733270
  4. Ask your PCP's office to send the referral to your insurance company
  5. Confirm with your insurance that the referral has been received and approved
  6. Provide us with a copy of your referral before your first appointment

Without an active referral (if your plan requires one), your insurance will not cover your sessions, and you'll be responsible for the full out-of-pocket cost.

Why We Can't Verify This for You

Here's the frustrating truth: Insurance companies often won't give us accurate information about your specific HMO plan, especially for out-of-state plans. They may tell us you have coverage, but when we bill your first session, we sometimes find out that's not the case.

The good news? You have more power than we do. As the member, insurance companies are required to give you accurate information about your benefits. They'll actually answer your questions clearly when you call.

What We Can Do to Help

We're here to support you, even though we can't verify your coverage directly. Here's how we can help:

  • Provide you with our Tax ID and Group NPI (listed above)
  • Provide your therapist's individual NPI so you can search for them specifically in your insurance portal
  • Answer questions about what to ask when you call your insurance
  • Bill your insurance once you've confirmed coverage (or once you've decided to take the risk)
  • Provide you with a superbill if you end up paying out-of-pocket and want to submit for reimbursement

Ready to Move Forward?

Before we can schedule your first appointment, please confirm that you've:

✅ Read and understood this information about HMO plans

✅ Either verified your coverage with your insurance OR understand that you're responsible for payment if your insurance doesn't cover our services

✅ Obtained a referral from your PCP (if your plan requires one - most don't!)

Reply to Keisha or Kiley's email to move forward with scheduling.

We're excited to support you in getting started with therapy!

We know insurance can be confusing and frustrating. We're here to help navigate it with you as best we can.