Understanding Your Insurance Benefits for Outpatient Mental Health

What is the name of your insurance company? ______________________________

What is the customer service number on the back of the insurance card? __________________________

(Hint: Insurance companies often refer to mental health as behavioral health. There may be a separate phone number for behavioral health. If so, call that one first.)

You will want to get to Benefits and Eligibility. You may have to follow the automated prompts until you reach a customer service representative.          

You want to say “I want to know my Insurance Benefits for Mental Health and find out how much it will cost for me to attend Individual Counseling.  I’d like the information for both In-Person and Telehealth options.” 

1.  Co-pay: A fixed amount you pay for covered health care services to providers who contract with your health insurance or plan.

2.  Deductible: An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. 

*Co-Insurance:  Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe.

3.  Please email me a list of Therapists for my area (zip code: 78666)

4. Is There Out of Network Benefits-to see a provider that does not take your insurance (less reimbursement and you will have to submit the claim yourself)

6. **Do I have access to an Employee Assistance Program? How many sessions are covered? What is the provider network?

Glossary of Health Coverage and Medical Terms:  https://www.healthcare.gov/sbc-glossary/

*Coinsurance is the amount you are obliged to pay for services after you have satisfied any copay or deductible required by your plan. Coinsurance is typically expressed as a percentage. For example, the representative might say your coinsurance is 20% after the deductible is met. This means the insurance will pay 80% and you pay the remaining 20% of the cost of the appointment after the deductible has been met.

**An EAP is a separate benefit from an employer so if your insurance is through a parents work, you may have access to an EAP. An EAP will cover a certain number of counseling sessions at no cost but you will have to speak to a representative with the EAP who will conduct a brief assessment and then tell you what it covers.  The EAP may have providers that are not providers with your insurance. If possible, try to select a provider that is also on your insurance so you can stay with this provider after the EAP sessions are completed.