Insurance In-Network Guide

Select providers at Upside Therapy and Evaluation Center are currently in-network with Blue Cross Blue Shield of Texas. This guide is intended
to assist you in determining your in-network benefits and out-of-pocket costs for services, particularly for psychological evaluations.

You are responsible for reviewing your benefits and contacting your insurance provider to verify coverage and determine any amounts you may owe.

1. Review the back of your insurance card.
2. Call the Member Services phone number listed on your card.
3. Follow the automated prompts to check eligibility and benefits. You will need the following information:
   • Insurance holder’s Member ID number
   • Client’s (person receiving services) date of birth
   • Client’s first and last name
4. Determine your in-network deductible, out-of-pocket maximum, coinsurance, and copay, as well as how much has already been met for each.
5. Confirm whether your plan covers the following therapy services:
   • CPT Codes: 90791, 90837, 90834, 90847, 90853 (therapy services)
   • Place of Service: Office (Code 11)
   • Provider Type: Professional
   • Provider NPI: 1184413999
   • Provider Tax ID: 87-4016564
   • Provider Name: Dr. Charleen Wilder
   • Diagnosis Code (if required): F41.1 (Generalized Anxiety Disorder)

   You may need to speak directly with a customer service representative. 

6. Confirm whether your plan covers psychological testing using the information below:
   • CPT Codes: 96132, 96133, 96136, 96137 (testing services)
   • Place of Service: Office (Code 11)
   • Provider Type: Professional
   • Provider NPI: 1184413999
   • Provider Tax ID: 87-4016564
   • Provider Name:< Dr. Charleen Wilder
   • Diagnosis Code (if required): F41.1 (Generalized Anxiety Disorder)

   You may need to speak directly with a customer service representative.

7. Determine whether preauthorization is required for psychological testing.
   • If preauthorization is required, request the phone number and/or website where the necessary forms can be obtained.