Step 1: Call the Member Services Number on Your Insurance Card:
Look for a phone number listed under “Mental Health”, “Behavioral Health”, or Customer Service. You can also check your insurance provider’s website for a member portal or chat option.

Step 2: Ask the Following Questions:
“Hi, I’m looking to understand my out-of-network benefits for mental health counseling. Can you help me check my coverage?”
Then ask these questions:

• Do I have out-of-network benefits for outpatient mental health?
  (This lets you know whether reimbursement is even an option.)

• What is my out-of-network deductible, and how much of it have I met?
  (You often have to meet this amount before getting reimbursed.)

• What percentage of the session cost is reimbursed after I meet my deductible?
  (This is usually a percentage like 60%–80% of the “allowed amount.”)

• What is the “allowed amount” for CPT Code 90837?
  (This is the code I use for 60+ minute individual therapy sessions.)

• Are there any limits to the number of sessions per year?
  (Some plans limit visits or require medical necessity.)

• Do I need any pre-authorization or a referral?
  (Rare, but important to know ahead of time.)

• How do I submit a superbill for reimbursement, and how long does reimbursement take?
  (I provide superbills upon request.)

Yes! Thrizer is an app where you can upload your superbill and they will take care of handling insurance claims and reimbursements. They also can provide an automatic benefits break down (benefits may not be fully accurate. it’s important to double check with your insurance provider to make sure it’s correct).