What To Ask Your Health Insurance Company To Check Mental Health & Therapy Benefits

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Insurance

Questions To Ask Your Health Insurance Company

Call the member services phone number listed on the back of your card.
Have your insurance card out when you call you will be asked to provide your member ID and other identifying information.
In Network Benefits Questions
Mental Health Coverage
What is my in-network deductible for outpatient mental health visits?
Deductible
How much of my deductible has been met? Does it apply to behavioral Health Treatment
Co-Payments
What is my copay for outpatient mental health visits? Is this coverage applicable before or after I meet my deductible?
Sessions & Authorizations
How many sessions per year does my health insurance cover? Is approval required from my primary care physician?
Telehealth Therapy
Are virtual outpatient mental health visits (or teletherapy) covered by my plan?

Out Of Network Benefits Questions

If we are not in-network with does your health insurance, ask your health insurance company the following questions to understand how much of sessions they will reimburse:
Mental Health Coverage
What is my out-of-network deductible for outpatient mental health visits?
Deductible
How much of my deductible has been met this year?
Co-Payments
What is my out-of-network coinsurance for outpatient mental health visits?
Referrals & Claim
Do I need a referral from an in-network provider or a primary care physician to see someone out-of-network?
How do I submit claims for out-of-network reimbursement?
Telehealth Therapy
Are virtual outpatient mental health visits (or teletherapy) covered by my plan?

Understanding You Benefits

Glossary of Healthcare Benefits Terms
  • Annual deductible

    The amount you pay each plan year before the insurance company starts paying its share of the costs. If the deductible is $2,000, then you would be responsible for paying the first $2,000 in health care you receive each year, after which the insurance company would start paying its share.

  • Copay/Copayment

    A fixed, up-front amount you pay each time you receive care when that care is subject to a copay. A copay of $30 might be applicable to a doctor visit, after which the insurance company picks up the rest. Plans with higher premiums generally have lower copays, and vice versa. Plans that do not have copays typically use other methods of cost sharing.

  • Coinsurance

    A percentage of the cost of your medical care. For example an individual therapy session that costs $160, you might pay 20 percent ($32). Your insurance company will pay the other 80 percent ($128). Plans with higher premiums typically have less coinsurance.

  • Annual Out-Of-Pocket Maximum

    The most cost-sharing you will be responsible for in a year. It is the total of your deductible, copays, and coinsurance (but does not include your premiums). Once you hit this limit, the insurance company will pick up 100 percent of your covered costs for the remainder of the plan year.

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