A GC student has helpfully provided some information for how to get reimbursed by ValueOptions, as well as a form to fill out:

1) For employer put CUNY and for Group either put CUNY or NYS023.

2) Don’t fill out part 2. I normally just write along one of the lines in big letters “See Attached Bill”.

  • On the Bill, you’ll just want to make sure that it has your therapist’s name and address, license number, CPT code, and a DSM code with 123.45 not just 123.4 (meaning you have to have the 5th number). You may also want to check your number to see if she is listing you as having a biological condition or not since that can affect coverage. They cannot ever technically deny medical though they can still deny you seeing your specific therapist for that condition.
  • They may also need a Tax ID on the bill, which is sometimes called TIN#. Location of Service is a code for provider’s office, though it’s uncertain whether this is necessary to include, according to the student.

3) Include the dates, rates and the provider’s signature.

4)  Then mail it to: Value Option, PO Box 1800, Latham, NY 12110

5) Make sure to scan the bill or take a picture first so that you have a copy in case they lose it.

 

(While the example from the student is in red, it is not necessary to fill the form out in red: the student who sent in this guide scanned in her filled-out copy with all but the date so she doesn’t have to write it in every time)

[gview file=”http://opencuny.org/healthdsc/files/2014/10/Blank-Value-Options-Claims_Form.pdf”]