Requesting a Gap Exception/Approval from your Insurance Company
Here is a good article that explains what a Gap Approval/Exception is, to help you understand it better.
Use these instructions for requesting Kendra Lay, AP/Be Well Healing Arts, LLC
for a Gap Exception for Acupuncture Services:
Questions to ask when speaking to your insurance company:
- Do I have acupuncture benefits? _____ (they should say yes...if we've already verified that you have them)
- If I have coverage, are there any providers (Acupuncture Physicians) in network in my area?
- If you have Aetna or Blue Cross, there are no Acupuncture Physicians in the Jacksonville area. There are a few chiropractors who do acupuncture, but if they try to send you to one of those you can tell them that you'd like to see someone whose primary specialty is acupuncture (An Acupuncture Physician). They might also show someone in network at the Mayo Clinic, but to my knowledge that provider is only providing oncology care and isn't available to the general public.
- If there are no providers in network, ask to apply for GAP authorization. This allows you to use in-network benefits with an out-of-network provider because there is a network deficiency.
- Can I be approved to be treated by Be Well Healing Arts, LLC? The NPI (National Provider Identification Number) is 1558781096. Provider is Kendra Lay, Florida Acupuncture Physician Florida license number AP3305
- Here are the treatment codes (CPT) that we'd be using, if they ask:
- If they ask for the EIN (Employer Identification Number) or Federal Taxpayer Identification Number for Be Well Healing Arts, LLC it is 46-3289559
- They will ask for some potential diagnosis codes that you’ll be getting treated for (ICD-10 Code). Kendra will give you these codes (ask her if she hasn't provided yet).
- Ask them for the reference number and fax number where I should send clinical information.
- After you make these request, I’ll fax that info to them. I'll do this ASAP, but it could take a few days for me to do it. After this is done, it will usually take 2-3 weeks for approval, depending on your provider. You may want to call them back in about a week after I send the faxed info to check up on the request. This may help to expedite things.