Questions to Ask Your Insurance Company
Coverage Basics
- Do I have outpatient mental health benefits?
- Is therapy/counseling covered under my plan?
- Do I need a referral or prior authorization?
Provider Details
- Is my therapist in-network or out-of-network?
- If out-of-network, what are my out-of-network benefits?
Costs
- What is my deductible, and how much has been met?
- What is my copay or coinsurance for each session?
- Is there a difference in cost for telehealth vs. in-person sessions?
Session Limits
- Is there a limit on the number of sessions per year?
- Are there any restrictions on frequency of visits?
Billing & Claims
- Do you require pre-authorization for certain services or diagnoses?
- Will I need to submit claims myself, or does the provider handle that?
- Are there any specific CPT codes I should be aware of (e.g., 90834, 90837)?
Supervision / Associate-Level Therapists (if applicable)
- Are services covered if provided by an associate or pre-licensed therapist under supervision?
- Are there any modifiers required (e.g., AJ) for reimbursement?
Other Important Questions
- Is there a separate deductible for mental health services?
- Are diagnoses required for coverage?
- Can you provide a reference number for this call?
