Finances
Mental Health Insurance Coverage
It’s important to understand your insurance so that you can determine if costs will be covered if you make an appointment with a mental health care provider.
Know Your Coverage
You are not required to use your insurance to pay for private care, but often people do. Keep in mind that you are responsible for paying any fees you incur that are not covered by your insurance.
Before You Schedule an Appointment
Prior to scheduling an appointment with a therapist it is important for you to contact your insurance company and find out what they will pay for and what your financial responsibilities will be. The questions below will help you to gather important information about your mental health insurance benefits, which will assist you with making informed decisions about therapy.
When submitting claims:
Common Insurance Terms
You’ll want to understand these common insurance terms to know the details of your coverage:
Claim: The request submitted to your insurance company by either you or your provider, asking them to help pay for the services you receive. Some policies require that the provider submit the claim and be reimbursed directly by the insurance company; other policies require that you pay your provider and then submit a claim.
Deductible: The amount you must pay out-of-pocket before your insurance company will begin to help cover your bills. For example, if your policy has a $100 deductible, you must pay the first $100 of the fees you incur for that insurance year.
Co-pay: The amount you pay for a service in addition to whatever your insurance company pays. For example, your insurance company may require that you co-pay a certain amount (i.e. $20) or a certain percentage (i.e. 20% of the bill) per visit, while the company pays the rest.
Benefits: The types of services and costs that your insurance policy covers. For example, some policies have no outpatient mental health benefits, require a referral/approval in advance, have a "cap" or upper limit of payment or require that you use only their "preferred" providers. You must determine the benefits of your policy by contacting your insurance company or by reading your policy carefully.
Content adapted from: http://counselingcenter.gwu.edu/mental-health-insurance-coverage
It’s important to understand your insurance so that you can determine if costs will be covered if you make an appointment with a mental health care provider.
Know Your Coverage
You are not required to use your insurance to pay for private care, but often people do. Keep in mind that you are responsible for paying any fees you incur that are not covered by your insurance.
Before You Schedule an Appointment
Prior to scheduling an appointment with a therapist it is important for you to contact your insurance company and find out what they will pay for and what your financial responsibilities will be. The questions below will help you to gather important information about your mental health insurance benefits, which will assist you with making informed decisions about therapy.
- Does my plan cover mental health outpatient visits?
- Do I have to see someone on the provider list?
- How does my coverage differ if I see a participating provider versus a provider "outside the network"?
- For how many sessions can I be seen?
- What is the percentage co-pay for sessions?
- Do I have a deductible that I have to satisfy? If yes, how much?
- Is there a pre-existing conditions clause for my plan? If yes, what is the length of time I have to wait prior to my insurance covering a pre-existing problem?
- Is my plan currently active? If not, when will it be activated?
- Do I have to fill out any paperwork or be pre-certified prior to seeing a therapist?
When submitting claims:
- What information will you need from my therapist in order for my claims to be paid?
- Where do I send my claims?
- Approximately how long does it take to receive a reimbursement?
- Is there anything I need to do to have my counseling sessions covered by insurance, if I am living out of state?
Common Insurance Terms
You’ll want to understand these common insurance terms to know the details of your coverage:
Claim: The request submitted to your insurance company by either you or your provider, asking them to help pay for the services you receive. Some policies require that the provider submit the claim and be reimbursed directly by the insurance company; other policies require that you pay your provider and then submit a claim.
Deductible: The amount you must pay out-of-pocket before your insurance company will begin to help cover your bills. For example, if your policy has a $100 deductible, you must pay the first $100 of the fees you incur for that insurance year.
Co-pay: The amount you pay for a service in addition to whatever your insurance company pays. For example, your insurance company may require that you co-pay a certain amount (i.e. $20) or a certain percentage (i.e. 20% of the bill) per visit, while the company pays the rest.
Benefits: The types of services and costs that your insurance policy covers. For example, some policies have no outpatient mental health benefits, require a referral/approval in advance, have a "cap" or upper limit of payment or require that you use only their "preferred" providers. You must determine the benefits of your policy by contacting your insurance company or by reading your policy carefully.
Content adapted from: http://counselingcenter.gwu.edu/mental-health-insurance-coverage