support@cmanamerica.org

Mental Health: How to Use Your Insurance for Counseling

How to Use Your Insurance for Counseling

  1. Contact your insurance company. Your insurance card should have a member services number written on the card. Sometimes there is a separate number for Mental Health or Behavior Health.
  2. You will be asked if you are a member or a provider. In all circumstances, you will follow the prompts as a “member”. You might be asked for your member ID number. This is located on your insurance card. You might also have to provide your date of birth or the date of birth of your guardian if you are a dependent of someone else’s insurance. (ex: Father’s Date of Birth if he is the individual who owns the policy).
  3. Once you follow the prompts and get connected with a customer service representative, let them know that you are seeking mental health services and would like some information regarding your benefits. Ask the following questions:
    1. Am I covered for Mental Health Services?
    2. Do I have a copay?
    3. Do I have to meet a deductible? (a deductible is the amount of money which you must pay before the insurance company’s coverage plan begins)
    4. Do I have a session limit?
    5. Do I need to be preauthorized? (prior approval is required by some insurance companies before benefit payments are granted)
  2. Ask for a list of 4-6 providers that are located close to where you live. Ask for a direct line to obtain more providers, should you need additional names.
  3. Once you get the names, call one provider at a time. Most times, you will have to leave a message. When setting up an appointment, double-check with the provider and make sure that they take your particular insurance.

 

Seeing an Out-of-Network Therapist:

  • You may also see a therapist in the community that is not a contracted provider for your insurance, this therapist is called an “out-of-network provider.”
  • Call your insurance company (or log in and look up details of your plan at your insurance website) and ask about your “out-of-network benefits.” Some insurance plans offer a lot of benefits for seeing out of network providers, some insurance plans have no out-of-network benefits at all. This is all determined by your specific plan. Most insurance companies have plans that have out-of-network benefits and plans that don’t.
  • If your plan has out-of-network benefits, these are subject to the yearly deductible, coinsurance, and out of pocket maximum stipulated in your plan. Often there is a different, higher yearly deductible for out-of-network services. Sometimes there may be a different out-of-network coinsurance and/or out-of-network out of pocket maximum as well. As an example, your yearly in-network deductible could be $2,000, but your out-of-network deductible could be $4,000.
  • If your plan has out-of-network benefits, you can see a therapist who is not a contracted provider for your insurance. In this instance, the therapist sets the fee for the service, and you pay that therapist upfront for the service.
  • The therapist then, upon request from you, can send a form to your insurance that shows that you saw this out-of-network provider, and the money you paid them for their services will go to your out-of-network deductible, and out of pocket maximum stipulated on your plan.
  • Depending on the specific stipulations of your plan regarding out-of-network benefits, yearly deductible, copayment, coinsurance, and out-of-pocket maximum—your insurance will reimburse you for a portion of the out-of-network therapy you received. They will send you a reimbursement check to cover at least a portion of the fee you paid to the out-of-network therapist. For example, if you’ve met the yearly deductible, and the out of pocket maximum, your insurance will cover your out-of-network fees for all services at 100% (but note: the insurance sets what their allowable fee is for each therapy service, which may be lower than what you paid to your therapist, so you will pay that difference).
  • When considering seeing an out-of-network therapist it will be important for you to know your plan stipulations and run the numbers to see if it is worth it to you financially and in every other way (for instance if you really prefer to see the out-of-network provider). In some cases, it is a better deal financially for you and for the out-of-network provider.