What To Ask Your Health Insurance Company To Check Mental Health & Therapy Benefits

If you are looking to use your health insurance to pay for therapy sessions, the first step is to learn what your insurance benefits cover. Many health insurances – particularly PPO plans – have great coverage, paying for the majority of your therapy session. Others – such as HMO plans – are more limited in coverage.

Get started by calling your health insurance company and asking the following questions. You can typically find your insurance company's phone number on the back of your insurance card, or by searching for it online.

Information to prepare prior to calling

Before you make the call, here is some information will make your call go smoother and allow you to gather comprehensive details around your coverage. You can ask the therapist you are considering for this information when you have an initial call with them as well.

Call the phone number for your health insurance company's Member Services. You may find this on the front or back of your insurance card.

Follow prompts to "Check Eligibility and Benefits" so that you get connected with the right representative.

Questions to ask your health insurance

When calling your health insurance company, it's important to find out a few things, such as your deductible amount, your copay or coinsurance amount, any special requirements to receiving coverage (e.g. referral from a primary care physician), and logistics (e.g. submitting claims for reimbursement).

The questions below will help you gather each of these data points! We recommend asking these questions, jotting down the answers, and sharing them with your therapist who can help you understand what each of these mean.

Questions about in-network benefits

If your therapist says they are "in-network with" or "paneled" with your health insurance, ask your health insurance company the following questions to verify that (1) you indeed can see them in-network, and (2) how much it would cost to see this provider:

Questions about out-of-network benefits

If your therapist says they do not take your health insurance, ask your health insurance company the following questions to understand how much of sessions they will reimburse:

Questions about teletherapy

Jot down or type up the answers that the health insurance company shares with you. Send it to your therapist or share it with them over a phone call so that they can help you understand how much therapy sessions with them will cost.

What happens after your therapy session

Pay the therapist's fee or your copay / coinsurance

At each therapy session, you will either pay the therapist's full fee (typically the case if you are seeing an out-of-network provider) or your copay amount (this is typically the case if you are seeing an in-network provider).

Submit a claim to receive out-of-network reimbursement

If you are seeing an out-of-network therapist, your therapist will typically send you a superbill on a monthly or more frequent basis. This is like a receipt or invoice for all of your sessions that also indicates the diagnostic code you can use to submit claims to your insurance company for reimbursement. You can then mail this to your insurance company (typically via snail mail but some insurances offer an online portal or email option as well; you can also use a tool like Reimbursify to facilitate this electronically) and receive the reimbursable amount via check. Some therapists offer the option to submit these claims on your behalf to the insurance company directly as well.

While fee and insurance-related questions can be cumbersome to deal with, you have a lot to potentially gain from understanding your benefits well. Don't be shy to ask your therapist to help you understand how it all works – that's part of their job, too!

If you have any questions we can help answer, shoot us an email at hello@zencare.co and we'll do our best to guide you to the right resources, too.