Questions to Ask Your Insurance About Paying for Anxiety Counseling
You may have what is call Out-Of-Network (OON) benefits as part of your mental health coverage. But, navigating the insurance system can feel daunting, overwhelming and time consuming. Here are some questions to ask and tips to make things go a little smoother.
In order to determine your OON benefits, I recommend contacting the customer service department for your insurance company to determine the coverage for your specific plan. This number is located on the back of your insurance card.
Ask The Insurance Representative These questions:
I am inquiring about my “out-of-network benefits for mental health counseling.”
What is my deductible?
How much of my deductible has been met for this year?
How many sessions per year does my health insurance cover?
Do I have a copayment for 90791 (intake sessions)? What is the allowed amount for these sessions?
What is my copayment or coinsurance for 90837 (53+ minute sessions) and 90834 (38-52 minute sessions)? What is the allowed amount for these sessions?
What is the “allowed amount"?
Can I see my provider more than once per week?
Are some diagnoses covered and others not? What diagnosis are not covered?
Are there requirements regarding medical necessity for certain diagnosis? What are they?
Are telemental health (virtual) sessions covered? Are there limitations to this coverage (i.e. video only)?
Do I need a referral from my primary care physician?
Do I need an authorization?
What paperwork/forms do I need to submit for sessions to be covered? Where/how do I submit these forms?
Tips:
To cut down on phone wait times, call as soon as the customer service department opens in the morning. Remember, some companies are located in different time zones, so you may be able to call earlier than 8:00am here.
If the representative you are speaking to indicates they are unable to provide certain information to you, ask to speak with a supervisor.
Write down the date and time you called, and request a reference number at the end of your call. This information will come in handy if there is ever a dispute with the insurance company about reimbursement.
If you receive conflicting information or something isn’t adding up, call back and speak to a different customer service representative.
Still Confused?
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