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Insurance Reimbursement Guide & Verification Script

Overview

CYRA Wellness is a cash-pay, membership-based practice. We do not participate with any insurance plans and do not bill insurance companies directly. However, our services are medical in nature, and you may be eligible for out-of-network reimbursement from your insurance provider or for payment via your HSA/FSA.

Our Role: We provide you with a Superbill (an itemized medical receipt) for clinical encounters. Your Role: You are responsible for submitting this documentation to your insurance company and managing any follow-up communication with them.

Step 1: Call Your Insurance Provider

Call the "Member Services" number on the back of your insurance card. Ask the representative the following questions to understand your coverage.

The Script:

"I am considering a membership-based telehealth program for specialized medical care. I would like to check my out-of-network benefits for the following:"

1. Telehealth Eligibility

"Does my plan cover out-of-network telehealth services provided in my home (Place of Service 10)?"

2. The Service Codes (CPT)

"What is the 'allowable amount' or reimbursement rate for these codes?"

  • 99204-95 (Initial 50-minute Consultation)

  • 99214-95 (Standard Medical Follow-up)

  • 99215-95 (Premium 50-minute Medical Follow-up)

3. The Diagnosis Codes (ICD-10)

"Are there any plan exclusions for the following types of care?"

  • Menopause/Hormones: N95.1

  • Weight Management/Obesity: E66.9

Step 2: Understand How Reimbursement Works

Reimbursement is determined by your insurance company, not CYRA Wellness. Please keep the following in mind:

  • Clinical Encounters Only: Insurance only reimburses for actual medical visits. If your program involves a month without a scheduled clinical appointment (e.g., visits every 5–6 weeks), a superbill will only be issued for the month the visit occurred.

  • Administrative Fees: Membership-based practices often include "Access Fees" (for messaging, technology, and administration). These fees are generally not reimbursable by insurance.

  • Deductibles: If you have an out-of-network deductible, your insurance may "approve" the claim but apply the amount to your deductible rather than sending you a check.

Step 3: Accessing Your Superbills

Once your clinical encounter is complete and the note is finalized, your Superbill will be uploaded to your OptiMantra Patient Portal. You can download it at your convenience to submit your claim.

Important Disclaimer: CYRA Wellness does not guarantee reimbursement. We do not communicate with insurance companies, provide letters of appeal, or manage prior authorizations for office visits. All fees paid to the practice are non-refundable regardless of insurance outcome.

Helpful Tips for Your Call:

  • Reference Number: Always ask the representative for a "Call Reference Number."

  • FSA/HSA: If using an HSA/FSA, keep your Superbills in a dedicated folder in case of a tax audit.

  • Pharmacy: Your insurance can usually be used for prescriptions ordered by our practice, provided you use in-network pharmacies.

  • Labs: All laboratory orders are sent to Quest Diagnostics. You may use your insurance for these tests at any Quest location; however, it is your responsibility to confirm that Quest is in-network for your plan.

  • No Guarantees: We provide medical coding for your convenience but do not guarantee reimbursement. We do not provide insurance navigation, appeals support, or prior authorizations for office visits.

Legal Disclaimer: > CYRA Wellness and Dr. Mondona Goodwin provide medical coding information for educational purposes only. Providing these codes does not constitute a guarantee of coverage or reimbursement. We are not responsible for denied claims, plan exclusions, or the specific reimbursement rates of your insurance carrier. Our relationship is directly with you, the patient, and your financial obligation to the practice is independent of any insurance outcome. We do not provide "Letters of Medical Necessity" for the purpose of insurance appeals or prior authorizations for office visits.