Many insurance policies require pre-authorization for services. Some insurance policies do not provide coverage for mental health services. There are requirements for the subscriber and the provider including differences in deductibles, co-pays, number of visits, or out-of-network benefits. If you want to use your insurance benefits, contact your insurance carrier for verification of benefits and/or pre-certification of services before the first scheduled appointment. See Guidelines, below, to use when contacting your insurance provider.
Your Privacy and Insurance Coverage for Mental Health
You may choose not to use your insurance benefits in order to maximize your personal privacy. Many laws are in place that are intended to ensure patients’ rights to privacy and protect patients’ records. However, insurance companies may request information about patients’ treatment. Some may ask only the dates of service, type of service and diagnosis. Other companies may request summaries of service, detailed reports, or even copies of progress notes. Sometimes insurance companies may deny payment for services if certain information is not provided. Some clinicians choose not to accept insurance in order to have greater control of their practice and privacy for their patients. If your clinician does not accept insurance, you may choose to file for reimbursement from your insurance company.
Call the Mental Health or Customer Service number on your insurance card and tell them that you “need to verify outpatient mental health benefits”.
Name of patient/client:
Name and member number of policy holder:
Name of Insurance Company:
Name of company handling your mental health benefits (sometimes different from the insurance company):
Phone number called:
Person you talked to at time of call:
Date and time of call:
Ask for the following information:
1) Is (doctor/therapist name and degree) currently a network provider for my plan?
2) If not, what are my out-of-network benefits?
3) Is pre-certification necessary?
4) If yes, enter the number of sessions approved and the CPT coded covered, the authorization number and date span covered.
5) Do I have a deductible for mental health services?
6) If yes, how much is it and how much has been met so far?
7) In what month does your policy year begin?
8) What is my co payment for each visit, or what is the percentage of coverage?
9) What are the restrictions or limitations to my coverage? a) pre-existing conditions; b) dollar amount per year? per lifetime?; c) number of visits per year? number of visits per lifetime?; d) is couples or family therapy covered?; e) is psychological or psychoeducational testing covered? If so, what are the benefits?
10) What is the billing address for claims?
By talking to your insurance company directly, you reduce the chance of having unexpected expenses.
If you have any concerns about the privacy and confidentiality of your treatment, please discuss this with your clinician. A complete “Notice of Privacy Practices” will be made available to you on or before your first visit.
*If the insurance company refuses to pay these claims for professional services, you are responsible for payment. **Please bring this form with you to your first appointment. If you have any questions, please call our office for assistance.
We are an association of independently practicing professionals providing an array of mental health services to individuals, couples, and families, including those with special needs.
We share certain expenses and administrative functions, but each professional is completely independent in providing you with clinical services, and each associate maintains separate records. Professional service fees may be covered by insurance companies.
Contact APA for more information or for an appointment. We respect your privacy and will hold your call in strictest confidence.