Understanding Insurance Benefits

Insurance can be confusing, and each plan varies. Below are some important questions to ask your insurance company so you can be informed about your plan’s coverage.

In-Network Benefits Questions

What are my in-network benefits for outpatient psychotherapy?

• Does my plan have a deductible I need to meet before coverage kicks in?

  • If so, how far into meeting my deductible am I currently?

  • Does my deductible restart at the beginning of each calendar year, or is it on some other timeline?

• Is there a copay or coinsurance that I will be responsible for paying each session?

• Are these benefits the same for Telehealth as they are for in-person services?

• How can I obtain confirmation that my provider is in-network with my plan?

Out-of-Network Benefits Questions

What are my out-of-network reimbursement benefits for outpatient psychotherapy?

• Will my reimbursement be based on my provider’s billing rate, or does my plan use a “maximum allowable billing rate” to calculate my reimbursement percentage?

• Are my reimbursement benefits the same for Telehealth as they are for in-person services?

• Do I have a deductible that I need to meet before out-of-network reimbursement benefits will begin?

  • If so, how far into meeting that deductible am I currently?

  • Is my out-of-network deductible different from my in-network deductible?

  • Does my deductible restart at the beginning of each calendar year or is it on some other timeline?

• What is the process for submitting superbills?

  • How and where do I submit for reimbursement (fax/website/email)?

  • What is the reimbursement window? How long do I have after the dates of service to submit my superbills?