Verifying

Benefits

After weighing the pros and cons of using third-party payment for mental health expenses, it is extremely important that you call your insurance company to VERIFY what your plan covers with a specific provider BEFORE your first session.

What to

Ask


Questions to ask:

  1. What are my mental health benefits for In-Network providers?
  2. What are my mental health benefits for Out-of-Network providers?
  3. Is provider number {NPI} in-network with my PLAN?
  4. What is my coverage for service code 90791 and 90837?
  5. Does my plan require a copay or coinsurance?
    • If copay, what dollar amount? ($25, $40, etc)
    • If coinsurance, percentage? (10%, 25%, 40%, etc)
  6. Does my plan have a deductible that needs to be met before insurance pays?
    • If yes, how much is it?
    • How much have I met for the year?
    • Does my plan run on a calendar year?

Provider NPIs:

  • Jeremy Smith : 1326381146
  • Amber Weir : 1790453645
  • Johnathan Roy: 1790120194
  • Sarah Smith : 1013266931
  • SC Clinic: 1770027880

 

 

A Humorous Take

on Calling for Benefits

 

 

  1. What are my in-network benefits?
  2. What are my out-of-network benefits?
  3. Do I have a high deductible plan?
  4. Do I have a low deductible plan?
  5. Is my plan copay or coinsurance?
  6. Is my specific therapist in or out of network with my plan? (offer NPI)
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