QUESTIONS TO ASK YOUR HEALTH INSURANCE WHEN INQUIRING ABOUT COVERAGE FOR MENTAL HEALTH TREATMENT


 

Does my plan cover mental health outpatient visits?

How much am I responsible for paying out of pocket?

Am I responsible for a co-pay each session or do I pay the entire fee, submit the claim to the insurance, and get reimbursed a percentage by them later?  Depending on the answer, how much is the co-pay and/or how much do I get reimbursed? 

How does my coverage differ if I see a participating provider versus a provider "outside the network" (meaning you can choose any provider)? 

If I have to see a participating provider, where can I get a copy of the provider list? 

For how many sessions can I be seen? 

Do I have a deductible that I have to satisfy? If yes, how much?

Do I have to fill out any paperwork or be pre-certified prior to seeing a therapist?

***If your health insurance was issued outside of  NY state, inquire about out of state benefits.



If you will be submitting claims:


What information will you need from my therapist in order for my claims to be paid?

Where do I send my claims?

Approximately how long does it take to receive a reimbursement?

When you contact therapists ask them if they are accepting clients who are insured by your insurance plan. Also find out if they will require you to pay for sessions when you are seen or if they will bill your insurance company.


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