Your insurance plan is between yourself, your employer, and the insurance company. Your insurance company is always going to offer more accurate information to you as the policy holder. The amount you owe out-of-pocket is determined by your plan and not by the provider or practice. Managed care plans such as PPO's and HMO's may require prior authorization. If you fail to obtain prior authorization, you may be required to pay for counseling services already provided. Some policies cover a percentage of costs and you as the consumer are responsible for the remaining percentage also referred to as your co-pay. Keep in mind co-pays are due prior to your session.
In addition, Telehealth sessions may or may not be covered by your insurance plan. Please make sure to verify with your insurance company to see if you are eligible and keep your therapist informed of any changes to your insurance. In order to determine your insurance benefit coverage and your predicted out-of-pocket expenses, you will need to call the customer service number on the back of your insurance card and ask the following questions:
• What are my “outpatient behavioral health benefits” for in-network providers and out-of-network providers?
• What is my deductible, co-insurance, or co-pay rate?
• Are Telehealth sessions included?
• Are benefits restricted to a specific platform?
• What is the name of the person you are speaking with?
• What is the confirmation number for this benefit verification?
Please note that ALL insurance benefit verifications are estimates only and it is not a guarantee of coverage. The actual amount owed may be more or less than originally estimated. As is the nature of using insurance, costs and coverage are only confirmed once the service has been consumed and claims are sent and received. Overall, therapy can be a significant and worthwhile expense.