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Dealing with insurance companies can often feel complex, challenging, and overwhelming. You are not alone. But it is always best to understand your mental health benefits BEFORE you need to use them. Mental health services may be covered in whole or in part by your health insurance or employee benefit plan. It is important to understand your mental health benefits as you will be responsible for any unpaid claims.

Here are some tips and questions to consider as you try to understand your mental health benefits:

  • Obtain a copy of your health insurance policy or employee benefit plan.
  • Review your health insurance policy or employee benefit plan to see what types of mental health services are covered.
  • Who manages your mental health benefits?
  • Are “out-of-network” benefits available?
  • What services and treatments are covered?
  • What is your deductible?
  • How much of your deductible has been met?
  • Once your deductible has been met, how much will you be reimbursed, or how much will be covered?
  • Do you have a co-pay?
  • Do you need prior authorization or precertification for mental health services?
    • If yes, obtain an authorization number
    • If you obtain prior authorization for psychotherapy sessions –
      • How many sessions will be authorized?
      • What is the maximum number of sessions you are allowed per year under your coverage?
    • What are the start and end dates for the authorized services?

Typically (but not always), PPO insurance plans may provide out-of-network reimbursement for certain mental health services. HMO insurance plans typically do not reimburse for out-of-network mental health services, but you should always contact your insurance company in advance at the phone number listed on your insurance card to verify out-of-network coverage.

  • If your insurance provides out-of-network benefits, then you need to ask your provider for a “superbill” (A “superbill” is an itemized form, used by healthcare providers in the United States, that details services provided to a patient).
  • Contact your insurance company and find out how to submit a “superbill” for out-of-network services
    • Fax – what is the fax number? (get a fax confirmation receipt)
    • Mail – what is the address? (keep a copy for your records and send via certified mail)
    • Online – is there an online portal? (this is usually the quickest way to submit claims for processing)

Last but not least, any time you call and speak with someone at your insurance company, make sure to write down the date and time of the call and the name of the person you spoke with. If they can provide a reference number for the call, that is even better.

If you or someone you know is suffering from mental illness or any other illness, and you are being denied benefits by your insurer, please call Kantor & Kantor for a free consultation or use our online contact form. We understand, and we can help.