Your Investment in Yourself

Although as providers, we would love to play the “how long can insurance have us on hold” game so that we could provide you with a crystal clear understanding of your benefits, we don’t always have the capacity to do that (most of us are one human operations) and even when we do, the first thing they tell us is that they cannot guarantee the accuracy of the benefits information they are providing. This means it is ultimately your responsibility for knowing and understanding your plan’s benefits. In order to help, here are some questions to ask your insurance company regarding eligibility, benefits, payments and insurance responsibility for services. Depending on your benefits it is possible for services to be somewhat covered by your plan or in incredibly rare instances, fully covered. Keep in mind not all of our providers work with insurance companies and not all services offered by our providers are services that insurance companies cover (for example: psychoeducational groups, workshops, some couples therapy, EMDR intensives, and therapy where a client chooses to forgo a formal diagnosis).

We’d recommend asking these questions to your insurance provider to help determine your benefits (In-Network):

• What’s my deductible for in-network mental health coverage?

• How much of my deductible has been met for the year?

• Is there a limit on sessions my plan will cover per year? (If yes, how many?)

• Does my policy cover 53 minute sessions (Billing code 90837)? (If yes, how many?)

• How much is my copay, or coinsurance, for outpatient mental health services?

• What is the policy year (i.e. Jan 1 – Dec 31)?

• Does my plan require a referral or pre-authorization for psychotherapy?

• Does my policy cover telehealth/teletherapy/tele-mental health/virtual visits using a secure HIPAA- compliant platform?

We’d recommend asking these questions to your insurance provider to help determine your benefits (Out-of-Network):

• Does my plan include out-of-network coverage for mental health services?

• What is my out-of-network deductible for mental health? Is this separate from my in-network deductible?

• How much of my out-of-network deductible has been met for the year?

• Am I limited by the number of sessions I can have per year? (If so, how many?)

• What is my out-of-network out-of-pocket maximum per year?

• What is my out-of-network coinsurance for mental health services?

• Do I need a referral to see someone who is out-of-network?

• What is the policy year (i.e. Jan 1 – Dec 31)?

• Does my policy cover telehealth/teletherapy/tele-mental health/virtual visits using a secure HIPAA- compliant platform?

• How do I submit forms for reimbursement? (Superbill)