What to ask your insurance before starting therapy
A free, step-by-step call script for checking your mental health benefits: whether a clinician is in network, what each session costs, session limits, telehealth, and out-of-network reimbursement.
Before you call
Your insurance card (member ID and group number are on the front).
The phone number for member services or behavioral health on the back of the card.
The full name of the clinician or practice you want to see. Ask them for their NPI number if you can; it speeds up the lookup.
A pen and paper, or this page open, to write down the answers.
About 20 minutes. Hold times vary.
1. Confirm you have mental health coverage
Does my plan include outpatient mental health (behavioral health) benefits?
Do I need a referral from a primary care doctor, or prior authorization, before my first visit?
2. Check the specific clinician
Is the clinician in network with my plan? Please check by name and by NPI number if I give it to you.
If I see someone out of network, what will I pay?
3. Understand what each session costs
What is my deductible for mental health care, and how much of it have I met this year?
After the deductible, do I pay a flat copay or a percentage (coinsurance) for each session?
Is there a limit on the number of therapy sessions per year?
Is the cost different for a 45-minute session than for a 60-minute session? (Ask your clinician which billing code they use. Common ones are 90834 for a 45-minute session, 90837 for 60 minutes, and 90791 for an intake evaluation.)
4. Telehealth
Are video therapy visits covered, and are they covered at the same cost as in-person visits?
Does the clinician need to be licensed in the state where I live for the visit to be covered?
5. If you want testing or medication care
Is psychological testing covered, and does it need prior authorization?
Are psychiatric medication-management visits covered, and at what cost?
6. If the clinician is out of network
Do I have out-of-network benefits? What is my separate out-of-network deductible?
What percentage do you reimburse, and is it based on your "allowed amount"? What is the allowed amount for my billing code?
How do I submit a claim for reimbursement? Can the clinician give me a receipt (sometimes called a superbill) and where do I send it?
7. Before you hang up
Can I get your name and a reference number for this call?
Is any of this written down in my plan documents, and where can I find it online?
Paying without insurance?
No insurance, or choosing not to use it? Under the federal No Surprises Act, providers must give people who are uninsured or paying out of pocket a Good Faith Estimate of costs when they schedule a visit or when you ask. You can ask any clinician for one before your first appointment. Many clinicians in our directory also list sliding-scale fees on their profiles.
This script is a planning aid, not insurance, legal or medical advice. Coverage varies by plan and by year, so what the representative tells you, and your plan documents, are what count. Write down the date, the representative's name, and the call reference number.