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Tips for Understanding your Insurance

You're wanting to start therapy and use your insurance?

As you likely already know, insurance can provide wonderful assistance in getting your medical needs met AND also incredibly difficult to navigate. Learning about what your coverage is before starting therapy can be tremendously helpful to ensure that you aren't surprised when it comes time to pay your copay, coinsurance, or deductible. It's also helpful to ensure that you actually have active coverage at the time of the therapy session. It is not uncommon for people to have their coverage end, not be aware of this, and then be responsible for the cost of the therapy session they attended during this time. We can't stress enough how important it is to get clear with your insurance provider on what your coverage is. You can do this by:

  1. Call the number on the back of your insurance card.

  2. Follow prompts for "Members".

  3. Get ready to wait to speak to a live representative.

  4. Ask questions and write down answers.

  5. Share with your therapist/clinic as needed.

*** BONUS: Get the name of the representative you spoke with & a reference number. This information is helpful if you have to call back and have issues with your insurance.

Other questions we recommend asking your insurance provider about is:

  • Do I have out-of-network benefits for behavioral health outpatient services? If so, what are they?

  • What are my in-network benefits for behavioral health outpatient services?

  • Is the therapist and clinic I want to attend paneled with my insurance? If they are not, is my insurance able/willing to authorize me to see this specific therapist/clinic?

** Must have therapist and clinic information available.

** Be mindful that there are times that a clinic accepts the insurance, but the therapist in the clinic might not. It can be helpful to verify that both the clinic and therapist are in-network. Be open to meeting with a different therapist if the clinic is in-network, but that specific therapist isn't.

  • Do I need to meet my deductible before mental health outpatient services are covered?

  • Do I have copays or coinsurance for outpatient mental health? If so, what is it?

  • Do I need prior authorization for services to be covered?

  • Is telehealth covered? If yes,

    • Can I meet with any provider or are there restrictions on who I can see?

    • Is the copay/coinsurance the same for telehealth services as it is for in-office services?

It is ultimately your responsibility to thoroughly understand and know what your insurance coverage is, when it changes, and when it is/isn't active. These are our tips to help you be as successful as possible navigating the world of insurance and healthcare:

  1. Talk to your insurance provider directly BEFORE starting therapy. Don't rely on what you hear from other sources. Insurance gives the most accurate and up-to-date information directly to their member.

  2. Be prepared to advocate for yourself. There may be a time when insurance has gotten something incorrect and you will need to be ready to contact them directly to clarify misunderstandings and advocate for the care you deserve.

The more you understand your coverage the better prepared you will be to use it effectively. Now, go call your insurance provider and get clear on your coverage! We'll see you in the therapy room after.


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