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:
- What are my mental health benefits for In-Network providers?
- What are my mental health benefits for Out-of-Network providers?
- Is provider number {NPI} in or out of network with my PLAN?
- What is my coverage for service code 90791 and 90837?
- Does my plan require a copay or coinsurance?
- If copay, what dollar amount? ($25, $40, etc)
- If coinsurance, percentage? (10%, 25%, 40%, etc)
- 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
- Sarah Smith : 1013266931
- SC Clinic: 1770027880
A Humorous Take
on Calling for Benefits
- What are my in-network benefits?
- What are my out-of-network benefits?
- Do I have a high deductible plan?
- Do I have a low deductible plan?
- Is my plan copay or coinsurance?
- Is my specific therapist in or out of network with my plan? (offer NPI)