How to Check Your Insurance Benefits

In the spirit of personal empowerment and self-responsibility, I strongly encourage my clients to check their mental health insurance coverage to understand what their financial responsibility will be for our appointments. I do not review details of a client’s mental health insurance coverage prior to initial sessions. I expect my clients to be aware of their mental health insurance coverage and financial responsibility for appointments if choosing to engage in services with me.

Section 1: Call the member services phone number on the back of your card, or start an online chat with member services through your insurance portal, and ask:

1. Is Cecropia Counseling LLC in-network with my insurance plan? (Group NPI 1699530584). 

If they cannot use those identifiers, please ask if Molly Silverman is in-network (Individual NPI 1689292989).

a. If yes, please continue to question 2.

b. If no, please scroll to Section 2.

2. Does my plan cover outpatient mental health counseling? (Below are the specific service codes - also called CPT codes)

90791: Diagnostic Clinical Evaluation (intake session)

90837: 60-minute individual counseling session

90834: 45-minute individual counseling session

90832: 30-minute individual counseling session

a. If yes, is there a limit to the amount of sessions that are covered?

b. Does my plan cover telehealth sessions? (place-of-service codes 10 and 02)

3. Do I have a deductible to meet before my in-network benefits for mental health counseling take effect?

a. If yes, how much is my deductible?

b. If yes, how much of the deductible have I met?

c. If yes, when does my deductible reset?

4. Do I have a copay or coinsurance fee for outpatient mental health counseling? 

a. If yes, how much is my copay or coinsurance fee?

5. What is the reference number for this conversation?  (This reference number will be necessary if you ever need to dispute a rejected claim)

Section 2: For out-of network insurance plans

1. Does my plan include out-of-network benefits for outpatient mental health counseling? (Below are the specific service codes - also called CPT codes)

90791: Diagnostic Clinical Evaluation (intake session)

90837: 60-minute individual counseling session

90834: 45-minute individual counseling session

90832: 30-minute individual counseling session

a. If Yes, do I need pre-authorization from a medical professional?

2. Is my reimbursement based on a percentage of the actual fee billed or of a particular maximum fee covered?

3. Do I have a deductible to meet before my out-of-network benefits take effect?

a. If yes, how much is my out-of-network deductible?

b. If yes, how much of my out-of-network deductible is currently remaining?

c. Once I meet my deductible, what percent of the cost of services will I be reimbursed?

4. What is the process for submitting out-of-network claims (where can I locate the claims form, can I submit multiple dates of service at once, etc.?)

5. What is the reference number for this conversation?  (This reference number will be necessary if you ever need to dispute a rejected claim)