Steps to Verify Your Insurance Coverage and Superbill Reimbursement

Locate your insurance card.
Find the Member Services phone number on the back of the card.

1. Call Member Services.
   Ask to speak with the Benefits Department and request information about your out-of-network benefits.

2. Take notes during the call.
   Write down the representative’s name, the date of the call, and any reference or call confirmation numbers.

3. Ask the following questions to understand your benefits clearly:

• Do I have out-of-network benefits for the services I have received or will receive?

• All visits with Bespoke Elemental Medicine are evaluation and management (E/M) visits, and most visits are provided via telemedicine (see codes below).

• What is my out-of-network deductible?
  (The amount you must pay out of pocket before insurance reimbursement begins.)

• How much of my out-of-network deductible has already been met?

• What is my coinsurance rate?
  (The percentage of the allowed amount that may be reimbursed once the deductible is met.)

• Does my plan require prior authorization for these services?

• How do I submit a superbill (online portal, mail, or fax), and is there a deadline for filing claims?

4. Provide CPT and ICD-10 codes for accurate benefit information.
   Insurance representatives can give the most accurate guidance when you provide:

• Confirm accepted CPT codes (procedure codes) and modifier. All visits with Bespoke Elemental Medicine are E/M visits, and most are conducted via telemedicine. Insurance companies vary in which CPT codes and modifiers they accept for telemedicine visits. Confirming this information in advance may improve your chances of reimbursement

• 60+ min visit for new patients:

• 99205 with GT or 95 modifier, OR

• 98003

• 40+ min visit for established patients:

• 99215 with GT or 95 modifier, OR

• 98007

• ICD-10 codes (diagnosis codes)

• Diagnosis codes for chronic and complex health conditions will often remain the same across multiple visits.

Important to Know

• We do not bill insurance directly.

• We provide a superbill for you to submit to your insurance company.

• Reimbursement is not guaranteed and is determined by your insurance plan.