Questions to guide your call to your insurance company when asking about out of network benefits
Call your insurance company’s Benefits Department (usually this phone number is on the back of your insurance card) and ask the questions below. Insurance can be confusing to navigate, so be sure to ask for clarification on anything you don't understand. It’s a good idea to take notes during this phone call so that you can refer to them later if you have questions or need a refresher.
Does my policy cover out-of-network Licensed Clinical Mental Health Counselor Associates? (My license number is A19050)
My therapist will provide the following information on a superbill: date(s) of sessions, diagnosis, and CPT code. Is this acceptable, or will you require additional information?
Does my policy cover:
Psychotherapy Initial Intake Interview — CPT code 90791 ?
Individual Psychotherapy — CPT code 90834 (a 45-minute session)?
Teletherapy — CPT code 90834-95 (a 45-minute session over a virtual platform)?
Are there any mental health diagnoses that are not reimbursable?
How many sessions are covered per year?
What is my lifetime maximum for mental health benefits?
What is my deductible for out-of-network services? Has it been met?
What is the Allowed Amount for therapy fees? (This is the maximum amount your insurance company will pay toward each therapy session.)
What percentage of the Allowed Amount will be reimbursed?
What is the process for filing a claim?
Do you require my claim to be submitted within a certain number of days from the date of service in order to be considered for reimbursement? If so, what is that time period?
What is the payment schedule? (This is the amount of time it will take them to process your paperwork and reimburse you.)
What is the phone number for the Claims Department so that I can follow up on the status of my claim?