Insurance

It is important to call your insurance company to find out exactly what mental health services are
covered. All plans have certain rules, limits, and procedures. Sometimes a pre-authorization for services
is required and often a deductible needs to be met before any reimbursements. In addition, there may
be a limit to the number of visits allowed per year and a maximum amount of
allowed charges per year and in a lifetime.

The following are some helpful questions that individuals can ask their insurance company:

  • Do I have mental health benefits?
  • If yes, do I need to see someone on the insurance company provider list only or am I also covered for out-of-network providers?
  • If I have out-of-network coverage, do I need to meet a deductible before receiving any reimbursements?
  • If I have out-of-network coverage and a deductible needs to be met, how much is the deductible and how much of it have I already satisfied this year?
  • With out-of-network benefits being used, once the deductible has been met, what does the insurance company consider to be the usual and customary individual psychotherapy (code 90834) fee for a licensed psychologist in my geographical area and what percentage of that fee does the insurance company cover?
  • How many sessions per calendar year does my plan cover? Please note: The number of sessions per calendar year, even if unlimited, is not a guarantee that the company will ultimately approve and/or cover this number of sessions.
  • Is there a maximum amount of charges allowed per year or in a lifetime?
  • Do I need pre-authorization from the insurance company or a referral or approval from my primary care physician before my first appointment?
Individuals without health insurance, mental health coverage, and/or out-of-network mental health coverage are encouraged to discuss their situation further with me.