Is psychotherapy covered by my out-of-network benefits?

Before starting therapy, I recommend first verifying your out-of-network benefits directly with your insurer. When using out-of-network benefits payment in full is expected at the time of the session. Reimbursement may be sought through using out-of-network benefits. Below is a list of questions you may wish to ask your insurance company to verify the final cost of counseling/psychotherapy services to you.

  • Does my policy cover mental health services provided by an out-of-network licensed psychologist?
  • What is my out-of-network deductible for outpatient* mental health for the year? (This is the amount you have to pay before you are eligible for reimbursement. Outpatient* simply means treatment outside a hospital. )
  • Are my medical and mental health deductibles separate? (Some insurance plans have separate deductibles for medical and mental health care. )
  • Has my out-of-network deductible been met this year? If not, how much has been paid towards the deductible?
  • What is my out-of-network coinsurance for outpatient mental health? (This is the percentage of the service fee that you are ultimately responsible for paying once the deductible is met).
  • Is there an “allowed amount”? (Some insurance companies cap the session fee that they will cover. )
  • Do I need a referral from an in-network provider to see someone out-of-network? (Some plans require a referral; some do not.)
  • How many mental health visits does my policy cover over the calendar year? Is there a limit?
  • Are there any diagnostic restrictions for coverage? Are some diagnoses covered and others are not?
  • How do I submit claim forms for reimbursement? (A claim is a form you complete and send to your insurance company to receive reimbursement for sessions.)