Insurance Verification Guide

Checking your insurance can be confusing. If you’re thinking about starting counseling with me, it helps to call your insurance company first. It’s also smart to check once a year, or any time your plan changes. This guide suggests what to ask so you can better understand your insurance coverage.

Calling Your Insurance Company

Call the member services number on the back of your insurance card. Ask for the Behavioral Health department. Have your date of birth and member ID number ready. Your member ID is on your card, and some plans use your Social Security number instead.

You can open the call with this line: “I’m calling to check my out-of-network mental health benefits. I’d like some information about my plan.”

What to Ask

Write down the answers as you go.

Call Details

• Write down the date of your call.
• What is your (the phone representative’s) name?
• What is the reference number for the call?

Your Plan Basics

• What is my policy effective date?
• What is my deductible (the amount you pay each year before your plan starts paying)?
• How much of my deductible have I paid so far this year?
• What is my out-of-pocket maximum (the most you’ll pay in a year; after that, your plan covers the rest)?
• Do my deductible, co-pays, and co-insurance count toward my out-of-pocket maximum?
• Do I have a co-insurance (what percent does my plan pay, and what percent do I pay)?
• Is there a cap on what the co-insurance percentage covers?
• Do I need a referral, and if so, who has to give it?
• Is telehealth (video sessions) covered?
• Is telehealth paid at the same rate as in-office visits?
• Are there any limits on the number of visits?

Service Types

For each session type below, give the representative the CPT code or codes. A CPT code is the billing code for a type of session. It tells the representative exactly which service to look up. Authorization means approval your plan has to give before it will cover a service.

First session (intake), regardless of ongoing service type: CPT code 90791

• Do I have a co-pay or co-insurance, and how much is it?
• Is there a limit on the number of intake sessions per year? If so, how many?
• Is authorization required for the first session?

Individual counseling: CPT code 90837

• Do I have a co-pay or co-insurance, and how much is it?
• Is there a limit on the number of sessions per year? If so, how many?
• Is authorization required for individual counseling?

Relational, couple’s, and family counseling: CPT codes 90846 and 90847

• Do I have a co-pay or co-insurance, and how much is it?
• Is there a limit on the number of sessions per year? If so, how many?
• Is authorization required for relational, couple’s, or family counseling?