Insurance Verification

How to Verify Your Insurance Benefits for Therapy

To check your mental health coverage, call your insurance provider and ask the following questions:

1. Does my plan cover mental health or behavioral health benefits?

2. Do I have a deductible?

  • If yes, ask:

    • What is my deductible amount?

    • How much of it have I met so far?

    • Is there a separate deductible for individuals vs. family members?

3. Do I have a co-pay or co-insurance for therapy?

  • If yes, ask:

    • What is my co-pay or co-insurance amount per session?

4. Do I need a referral or prior authorization to see a therapist?

5. Does my plan limit how many therapy sessions I can have per year?

  • If yes, ask:

    • How many sessions are covered?

    • Can I request additional sessions if needed?

6. Are there any exclusions in my plan for therapy?

  • This is rare, but some plans do not cover specific diagnoses or services.

What if We Are Not "In-Network" with Your Insurance Plan?

If we are not in-network with your insurance, ask your provider about Out-of-Network (OON) benefits:

1. Do I have Out-of-Network benefits for mental health?

  • If yes, ask:

    • Do I need a referral or prior authorization to use my OON benefits?

    • How much will my insurance reimburse for therapy sessions? (They typically reimburse a percentage of the session cost.)

    • What is the process for submitting claims? (Ask if they require a fax number, mailing address, or online submission.)

How Out-of-Network Billing Works

  • If using OON benefits, you will pay the full session fee at the time of service.

  • We will provide you with a superbill to submit to your insurance company for potential reimbursement.

What is a Superbill?
A superbill is a detailed receipt that includes the necessary information for insurance reimbursement. You submit this directly to your insurance provider.

Key Takeaways

✔ Always check your specific plan’s details—every insurance provider is different.
✔ If you have Out-of-Network benefits, you may be eligible for partial reimbursement.
✔ We are happy to provide a superbill to help with reimbursement, but clients are responsible for submitting claims.