Questions to ask your insurance provider before your first session

It is important to be informed about your health insurance benefits. This is especially true when seeking services like mental health therapy or medication management! What your insurance plan covers for these services might be slightly different than regular doctor’s office visits, or it can be quite similar. There is no way to know unless you call the number on the back of your card, often called “member services.” Here are some questions you might ask after providing an agent your information.

What are my benefits for psychotherapy? This is for outpatient, at a clinic. 

Do I have Telehealth benefits, too?

Is this provider in-network with my plan? (provide information)

What is my copay or coinsurance responsibility?

What is my deductible?

Is the deductible waived for my psychotherapy benefits?

Do I need a referral from my primary doctor, or an authorization?

How many sessions do I get in a calendar year?

Can I have multiple sessions per week?

Is there anything else I should know about for this benefit?

When you call, the robot voice prompts might ask you to check your benefits in their online portal. You are free to do so, but typically, you won’t get the level of detail described above unless you find your “summary of benefits.” Those documents are often lengthy and inaccessible, and you aren’t trained to know what the information even means! If you need extra help understanding this information, don’t hesitate to stay on the line or ask for a representative until you get a live person to help you.

Mental health clinics typically have billing staff who may help you navigate these situations, especially when dealing with things like denied claims or a surprise charge from insurance. Sometimes, they might call insurance on your behalf, but insurance plans are likely to give more information to the member themselves. At Kirkland EMDR Counseling, you may email our office staff through our office email, Contact Us Secure Form, or leave us a secure voicemail at (425) 216-8850.