How to Apply for an In-Network Exception

Overview:

Ramalaxmi (Rameya) Shanmugavelayutham, LCSW, is an Out-of-Network (OON) provider, which means she does not bill insurance directly.

Clients:

  • Pay at the time of service (credit card, Venmo, or FSA)

  • Receive a superbill (receipt) to submit for potential reimbursement

If your plan allows, you may be able to request an In-Network Exception—so you can use your in-network benefits with her care.

What Is an In-Network Exception?

An In-Network Exception (also called a Network Gap Exception or Geo-Waiver) allows you to receive care from an out-of-network provider at in-network rates.

This is often approved when:

  • No comparable specialist is available in-network

  • You require specialized treatment not easily accessible

Why You May Qualify

Rameya provides specialized, evidence-based therapies that are often difficult to find in-network, including:

  • EMDR (Eye Movement Desensitization and Reprocessing)

  • Dance/Movement Therapy

EMDR is widely recognized as a gold-standard treatment for:

  • PTSD

  • Acute Stress

  • Adjustment Disorders

  • Co-occurring conditions

If your insurance network lacks providers with this level of specialization, you may qualify for an exception.

Step-by-Step: How to Request an Exception

Step 1: Understand Your Coverage

Call the number on the back of your insurance card and ask:

  • What are my Out-of-Network mental health benefits?

  • How do I apply for an In-Network Exception?

Step 2: Request the Exception

Ask to speak with someone in Mental Health Benefits and request:

  • In-Network Exception (BCBS PPO)

  • Geo-Waiver (BCBS Blue Choice)

  • Network Gap Exception Request Form (United Healthcare)

  • (Other insurers may use similar terms)

Step 3: Use This Script

You can say:

“I would like to use my in-network benefits for an out-of-network provider. The provider is Ramalaxmi Shanmugavelayutham, LCSW, who specializes in EMDR therapy for PTSD. Her services are not available in-network in my area.”

If applicable, also mention:

  • You were referred to this provider

  • You were unable to find appropriate in-network care

Provider Information (You May Need This)

  • Name: Ramalaxmi Shanmugavelayutham, LCSW

  • Address: 2389 Main St Suite 100, Glastonbury, CT 06033

  • Tax ID: 93-1935884

  • NPI: 1962998914

  • Email: Rameyalcsw@gmail.com

Common CPT Codes

Your insurance may ask for these:

  • 90791 – Initial Intake (60 minutes)

  • 90837 – Standard Session (60 minutes)

  • 90834 – Short Session (45 minutes)

What Happens Next

  • Insurance review may take several days to a few weeks

  • You may need to follow up for updates

  • Insurance may contact Rameya directly (usually after your first session)

If Your Request Is Approved

  • You will still pay upfront

  • Your insurance should reimburse you at in-network rates

  • Confirm reimbursement details directly with your insurance provider

If Your Request Is Denied

  • You may be able to appeal the decision

  • Rameya can help support your appeal

  • Sliding scale or reduced rates may be available

Navigating the
Out-of-Network Process

  • Before starting, it’s helpful to:

    • Call your insurance to verify OON benefits

    • Understand your deductible and reimbursement rates

Need Help?

If you have questions or want support with your request or appeal:

Contact: Rameyalcsw@gmail.com

Rameya is happy to help you advocate for access to the care you deserve.