Have you ever wondered “is the provider I want to see in-network?” or “how much will sessions cost if I use my insurance?” A quick call to your insurance company and knowing what to say will give you all the answers you’re looking for.
In this article you’ll find:
Who to call
What to say on the call
A breakdown of common terms you’ll hear
Who do I call to get this information?
Start by calling your insurance company. While the provider’s office may look this information up for you, here is what to do if they don’t offer this service.
Look on the back of your insurance card. You will often see a phone number next to “For Members”. Use this number.
No insurance card? Log in to your online insurance member portal.
No insurance portal? If you know what carrier you have (e.g., Cigna, United, Aetna), then do an internet search for “member phone number for [name of your insurance carrier].”
What do I say on the call?
There are two things you may want to do on this call:
Check to see if a certain provider is in-network (INN) with your plan. Or, if you don’t have a specific provider in mind, you may want a general list of options.
Learn what your benefits are and how much you will pay for sessions.
Regardless of which of these questions you want to ask, start with these steps:
Call your insurance company.
State that you are a member, calling to ask about your Mental Health Benefits.
Note: It is important to state that you want to know your MENTAL health benefits as these are often different than your MEDICAL benefits, and handled by different departments.
Is my provider in-network?
Now that you are speaking to an insurance agent in the correct department, you may want to check if a provider is in-network by saying …
“I would like to check if [insert provider’s name] located at [state their address from their online profile/website] is IN or OUT of network with my mental health benefits.”
If you don’t have a specific provider in mind and you’re calling to get a general list of folks who are INN then say:
“I would like a list of providers who are IN-NETWORK with my benefits, who offer Outpatient Mental Health Benefits and specialize in [e.g., trauma, depression, ADHD].”
Checking my benefits
Next, you’ll want to ask what your benefits are so that you can anticipate how much sessions will cost. To do so, ask these questions:
“What are my in-network Outpatient Mental Health benefits?
Do I have a copay ($) or coinsurance (%) amount? If so, which one and what is it?
Do I have to meet a deductible and/or out of pocket max? If so, which one(s) and what is it?
(If you have a deductible) Once I’ve met my deductible, how much do I pay for sessions? Then, once I’ve met my out of pocket max, how much do I pay?
(If you have no deductible, just an out of pocket max) Once I’ve met my out of pocket max, how much do I pay for sessions?”
What if the provider I want to see is out-of-network (OON)?
If you want to see a provider that is OON, then when you call your insurance company, ask:
“Do I have out of network mental health benefits?”
If YES, then ask what your OON benefits are using the script above. Note: Some OON insurance benefits do not have a deductible, out of pocket max, copay, but rather, pay you a flat rate discount per session.
If NO, this means that you do not have any OON mental health benefits and will need to either find an INN provider, or pay out of pocket to see the provider you want.
What if I don’t have ANY mental health coverage, either INN or OON?
While this is rare, this unfortunately means that you will have to pay for mental health benefits out of pocket regardless of who you go to. You can go to any provider you’d like, but you will be paying 100% for those services.
If you don’t have any mental health benefits to use, or if there is no one near you that takes your insurance, here are three other options:
Providers who offer discounted rates.
Providers who offer sliding scale rates. However, you will need to provide financial hardship in order to qualify for this.
Many large universities have student-run counseling centers. Because your provider will be a student in training who is working closely with a licensed supervisor, these sessions are usually a much lower cost.
Common Terms
What is a deductible or an out of pocket max?
What is the difference between in versus out of network benefits?
The language used to describe your insurance benefits may be very confusing, as they don’t come up in everyday conversations. For a breakdown of 20+ common terms, click THIS link for more information.
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