When it comes to checking your mental health insurance coverage you need to make sure everything is managed from your side. By contacting your insurance company regarding your in-network or out-of-network insurance coverage, you may want to ask the following questions to ensure you are provided with the correct information:

  • Do I have mental health benefits for outpatient psychotherapy services?
  • Do I also have out-of-network benefits, so I can freely choose my provider?
  • Are individual, group or family therapy (usually with someone under 18) covered?
  • Is couples therapy covered specifically? (which is very different from family therapy and not covered most of the time.)
  • Is my diagnosis (a diagnosable and verifiable mental disorder is a requirement in order for the insurer to pay for any therapy, no exceptions) of ___________ (for example: panic disorder, post-traumatic stress disorder, major depression, bipolar disorder, schizophrenia, attention deficit and hyperactivity disorder, alcohol or substance dependence, etc.) covered by my policy? (if you’re troubled by this requirement, you can pay privately and bypass the risk of your diagnosis becoming part of a major health record database and/or possibly vulnerable to data breaches – Caveat Emptor, Latin for “let the buyer beware”.
  • Does my policy have a yearly cap?
  • Do I need an authorization (especially for EAP services) or certification prior to receiving any mental health services?
  • What is my deductible and how much been met so far for this year?
  • What is my yearly out-of-pocket maximum and how much has been met?
  • How many sessions does my plan cover with a therapist or psychologist per calendar year?
  • What are the usual customary rates for in office professional mental health services by a therapist or psychologist (codes: 90791, 90834 & 90837) in my zip code?
  • What percentage of the usual and customary rate does my plan cover with an out-of-network therapist or psychologist?
  • Be sure to write down and keep this information for your records: the name and badge number of the agent you spoke with, the date, time and the confirmation number for that call. Please be sure to also write down your questions as well as the agent’s exact responses, just in case you need them later to support your claim.

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