Insurance is something that most of us never learn how to truly navigate and choose. It’s another realm of adulting that’s complicated and although I cannot help you navigate all the ins and outs of your insurance policy, I can at the very least assist with steering your inquiries when it comes to mental health benefits.

If you’ve attempted to find a new therapist recently, you may have noticed that there are a lot of providers who no longer bill insurance. Without going into a rabbit hole about why that is, I’ll give you a bit of a cheat sheet into questions to ask to still use your insurance benefits even if your therapist doesn’t bill or accept your insurance.

It is important to know your specific policy; this is easier said than done. Knowing the ins and out of your policy includes knowing what’s covered when and under what circumstances. With insurance renewals approaching, this is something that you’re going to want to pay closer attention to before your plan auto-renews to assess whether the policy you choose works for your lifestyle. Health insurance policies are usually tiered by the type of services: routine, outpatient, inpatient, and emergency. Most don’t realize that mental health coverage is usually considered an outpatient service rather than routine like your physicals or eye exams. This means you must understand how payment is dictated for outpatient services, which may be different than routine services. You may have a coinsurance rather than a copay, especially if your deductible for the year has not been met. If you're comparing plans via your employment or the Health Marketplace, considering your lifestyle and projected health changes may assist in choosing health benefits you can actually utilize throughout the year.

Here are a list of questions to consider or ask upon choosing your next healthcare plan:

What is my deductible amount and does this meet the criteria to obtain a health savings account (HSA)?
Will my employer match money put into an HSA?
Would I be required to pay a coinsurance or a copay for outpatient mental health services and what is the amount that I am expected to pay upon service?
Does the coinsurance go towards my deductible or out-of-pocket costs?
Is my coinsurance based on a maximum session cost?
How many sessions are covered under my policy per year and is that session amount based on my diagnosis?
Are mental health services considered a speciality and therefore a referral is needed?
Can my self-pay cost for mental health services be reimbursed under my out-of-network benefits or counted towards my out-of-pocket costs?
Is relational or family therapy covered under mental health benefits?
Is it more cost effective to choose a provider out of network after reviewing what my insurance will pay for?
What is the process to submit a claim for reimbursement?
What is needed on the superbill for reimbursement?

*Disclaimer: Content is for informational purposes only and is not intended for or to be considered legal, educational, medical or healthcare advice.