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Questions to Ask Your Health Insurance Company

  • Does my insurance plan cover outpatient and/or inpatient mental health services? If so, what kind of services? (e.g., individual counseling, psychological assessment, group counseling, couples counseling, psychiatric evaluations and/or medication management)

     

  • Does my insurance plan require pre-authorization for services obtained?

     

  • Does my insurance plan authorize me to see only certain mental health professionals? (i.e., Psyhiatrists, Psychologists, Licensed Counselors, Licensed Social Workers, etc.)

     

  • Do I need to obtain a mental health provider referral from my primary care physician (PCP) for these services?

     

  • May I have a list of counselors in my area whom are on your preferred provider list? (Many insurance companies have an arrangement with some counselors for a larger percent of coverage of the fees associated with counseling)

     

  • If I want to see a provider that is not on the preferred provider list, how much of the cost will insurance cover?

     

  • Is there a limit to the number of sessions my insurance will cover in a benefit year? Can a counselor request that the number of sessions be extended?

     

  • Is there a co-pay for services? If so, what is the co-pay amount? (A co-pay is the fee you pay out-of-pocket at the time of the appointment.)

     

  • Does my plan have a deductible? If so, how much is the deductible? (The deductible is how much you have to pay before the insurance will start paying for some or all of the counseling fee. For example, if the deductible is $100, then you must pay the first $100 of the covered medical costs before the insurance will pay anything at all.)

     

  • Does my insurance plan have a maximum benefit (maximum dollar amount) they will cover per calendar year for mental healthcare services?

     

  • Do I pay the counselor and get reimbursed by the insurance company or does the insurance company pay the counselor directly? (if the insurance company reimburses you, ask for the form(s) you will need to fill out and submit to get reimbursed.)