Determining Your Mental Health Coverage

Call your insurance carrier by calling the number on the back of your card listed for mental health. Check your coverage carefully and find the answers to the following questions:

  • Ask if you have “out-of-network” benefits?

  • Is there a deductible that must be met first and how much is my deductible?

  • What is the coverage amount for the assessment (90791) and therapy sessions (below)? Usually, the insurance company reimburses a percentage of what it has deemed “usual and customary”. Typical CPT codes (updated as of Jan 1, 2013) used would include:

    • 90791: Psychiatric diagnostic interview

    • 90832: Psychotherapy, 30 minutes with patient and/or family member

    • 90834: Psychotherapy, 45-50 minutes with patient and/or family member

    • 90837: Psychotherapy, 60 minutes with patient and/or family member

    • 90846: Family psychotherapy without the patient present

    • 90847: Family psychotherapy with patient present.

  • How many therapy sessions does my plan cover?

  • Is approval required from my primary care physician?

  • What is the process for getting reimbursed for out of network services?

A note on out-of-network services

While out-of-network services may seem higher initially, they can offer key benefits:

  • Personalized Treatment Plan: Out-of-network care allows us to develop a treatment plan based on your specific needs, free from insurance constraints. This means we can tailor the therapy’s length, intensity, and type to your individual needs.

  • No Third-Party Involvement: By choosing out-of-network services, you avoid delays or complications often caused by insurance company involvement in billing or paperwork. No treatment authorizations needed nor their-party review of your personal information.

  • Long-Term Value: Out-of-network therapy is an investment in high-quality, effective treatment designed to address issues thoroughly rather than temporarily. This approach often leads to more sustainable outcomes and potential cost savings by reducing the need for prolonged or repeated therapy in the future.