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Understanding Insurance Benefits

March 26, 2018

 

Here are some commonly asked questions about mental health insurance coverage. Hope this helps to de-mistify the process.

 

What is an out-of-network claim?

 

An out-of-network mental health claim is a request for your health insurance company to reimburse a bill from a psychotherapist who is not contracted with your health insurance company.

 

Do all health insurance policies reimburse out-of-network claims?

 

No, not all policies reimburse out-of-network claims. Call the customer service number listed on the back of your card to check with your insurance company about out-of-network mental health coverage.

 

What is a deductible?

 

A deductible is a set amount of money you are expected to pay before your insurance will start paying for your mental health care. This amount is determined by your specific policy and is set in advance.

 

What is an out-of-pocket maximum?

 

The out-of-pocket maximum is the total amount of money you can be required to pay towards your mental health care before your health insurance policy begins to pay 100% of the therapy costs. This amount differs from plan to plan but usually resets each year. There is usually one maximum per person and a higher maximum per family.

 

What if a therapy claim is rejected?

 

If a psychotherapy claim is rejected, determine the reason for the rejection. If it is due to missing information, lack of preauthorization, or another administrative error it can be corrected an resubmitted.

 

How long will it take to get reimbursed?

 

This depends on your insurance company and the complexity of your claim. Often it is wise to contact your insurance company regularly to expedite the process as much as possible.

 

How much money will I get back?

 

This depends on your specific insurance plan and your deductible.

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