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Is the therapist I want to see In-Network (in my health insurance network)?
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What is my deductible (what I have to pay before my insurance starts paying) for in-network mental health benefits?
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How much is my co-payment (my cost-sharing portion of the bill) for mental health services?
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Does my plan limit how many therapy sessions are allowed per year?
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What is the policy year (i.e., Jan 1 – Dec 31)?
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Does my policy cover 60-minute sessions?
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Does my policy cover telehealth (if this is a service you would prefer)?
IF THE THERAPIST YOU WANT TO SEE IS NOT IN YOUR INSURANCE NETWORK, YOU MAY WANT TO FIND OUT IF THEY ARE AN “OUT-OF-NETWORK” PROVIDER FOR YOU. SOME INSURANCE COMPANIES WILL STILL ALLOW YOU TO SEE THIS THERAPIST, BUT THEY MAY REQUIRE YOU TO PAY A HIGHER CO-INSURANCE/PORTION OF THE BILL. IN THIS CASE, YOU WILL WANT TO ASK:
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Does my insurance company allow Out-Of-Network (OON) Mental Health Benefits?
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If so, how much does my insurance pay for an OON provider? This is usually a percent (i.e., 70%).
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Does my OON payment count toward my deductible? If so, what is my OON deductible? Is it different than my in-network deductible?
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Does my OON payment count toward my deductible?
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Is approval required from my primary care physician (i.e., pre-authorization)?
IF YOU DECIDE TO SEE AN OUT-OF-NETWORK THERAPIST, YOU WILL BE RESPONSIBLE FOR THE PORTION OF THE BILL THE INSURANCE COMPANY DOES NOT PAY.
The process works like this: you have a therapy session and pay for the session in full at the end of the session. Your therapist gives you a SuperBill as a receipt for your payment. You send the SuperBill to your insurance company and they reimburse you according to their Out-Of-Network rate. For example, if you have Out-Of-Network benefits at 70%, you will pay for 100% of the therapy session cost and get reimbursed 70% of that payment by your insurance company.
Some people choose not to use insurance at all, using a direct pay option. In this case, you would pay for the session with HSA, check or credit card. Your therapist may offer a reduced day-of-service rate.
GOOD FAITH ESTIMATE
If you are not enrolled in a plan or coverage or a Federal health care program (uninsured individuals), or are enrolled but not seeking to file a claim with your plan or coverage (self-pay individuals), you may request a good faith estimate of the expected charges you may be billed for.