COACHING: What to consider when calling my insurance company.

When calling your insurance company to inquire about therapy session coverage (Behavioral Health), it’s essential to ask specific questions to ensure you have a clear understanding of your benefits and potential out-of-pocket costs. Here are some questions you may want to consider:

1. Network Coverage:
   • Are therapy sessions covered under my current insurance plan?
   • Do you have a network of preferred mental health providers?
   • Can you provide me with a list of in-network therapists in my area?
2. Referral Requirements:
   • Do I need a referral from my primary care physician to see a mental health professional?
   • Are there any pre-authorization requirements before starting therapy?
3. Coverage Details:
   • What is the coverage limit for therapy sessions (e.g., number of sessions per year)?
   • Is there a deductible that I need to meet before coverage kicks in?
   • What percentage of the therapy cost will the insurance cover?
   • What is a estimated contracted rate?
   • Are the following codes coved and at what cost? (90791, 90837, 90834)
4. Out-of-Pocket Costs:
   • What is my co-payment or co-insurance for each therapy session?
   • Are there any additional fees or charges I should be aware of?
   • How does the coverage change if I see an out-of-network therapist?
5. Authorization Process:
   • What is the process for obtaining authorization for therapy sessions?
   • How long does it typically take to get approval for mental health services?
6. Types of Therapy Covered:
   • Are all types of therapy covered, or are there specific modalities that are excluded?
   • Does the insurance cover individual, group, or family therapy sessions?
7. Telehealth Options:
   • Does the insurance cover telehealth or online therapy sessions?
   • Are there any differences in coverage for in-person versus virtual sessions?
8. Billing and Claims:
   • How does the billing process work for therapy sessions?
   • What information do I need to provide when submitting a claim?
9. Appeal Process:
   • What is the appeals process if a claim is denied?
   • Can you provide information on how to dispute or appeal a denied claim?
10. Emergency and Crisis Coverage:
    • What mental health services are covered in case of an emergency or crisis situation?
    • Is there a hotline or specific protocol for urgent mental health needs?

Remember to take notes during the call, including the representative’s name, date, and a summary of the information provided. This can be helpful for reference and documentation if you need to follow up later.