Questions To Keep In Mind When Learning About Your Insurance Benefits
A list of questions about the coverage of mental health services by your insurance to consider researching or asking your insurance agent.
First, does your insurance company cover mental health care services?
Do you need a referral from your primary care physician to get insurance to cover the treatment?
Do you need a precertification from your insurance company to receive mental health care? (Ask for their precertification list)
How many sessions per year does your health insurance cover?
What is the coverage amount per therapy session? (Ask if you have a deductible and if you need to pay a copay or coinsurance per session)
Do you need renewed approval for each session?
Does your insurance cover out-of-network providers? (Also ask how you can access a list of in-network providers in your location). If you can see both in-network and out-of-network, does the percentage / amount paid by your insurance company vary?
Is there a specific list of diagnoses for which services are covered?
Is there a difference between your benefits for inpatient versus outpatient treatment?
(Depending on diagnosis and symptoms) If you are going to be hospitalized or receiving inpatient care, how many days are you allowed to stay?
What prescription benefit does your policy offer? What are the copays for medications? Are there different levels of prescription coverage depending on the specific medication (i.e. do copays vary depending on whether the medication is generic or name-brand)?