It’s important to call your insurance company to verify your benefits and understand how therapy will be covered. Before you call, have this information handy:
Provider’s full name: Tessa Kinsey, LMFT
Provider’s NPI: 1457197998
Health insurance card: Have your health insurance card handy so you have the insurance company’s phone number, your Member ID number, and any other plan details you may be asked for.
Full name and date of birth of the subscriber: If you are on your parents’ or spouse’s health insurance plan, you’ll want to have their name and DOB prepared and ready to provide.
CPT Codes: indicate what service is being billed
90791 for the intake appointment (if applicable)
90837 - ongoing psychotherapy
90847 couples therapy (if applicable)
Call the phone number for your health insurance company’s Member Services. You may find this on the front or back of your insurance card. Follow prompts to “Check Eligibility and Benefits” so that you get connected with the right representative. Note that there might be a different line for Behavioral Health.
Is this provider in-network with my health insurance? (This may vary by the particular plan, so it is important to check!)
If your plan is not local, you can tell them that your provider is in-network with the local (Highmark) plan and that services will be rendered in PA.
What is my in-network deductible for outpatient mental health visits? (Important because there might be a separate mental health deductible)
How much of my deductible has been met?
What is my policy period? (This may be different than the calendar year)
What is my copay or co-insurance for outpatient mental health visits?
Is this coverage applicable before or after I meet my deductible?
Is there a limit on the number of sessions per year?
If yes, how many individual therapy sessions per year?
Are virtual outpatient mental health visits (or teletherapy) covered by my plan?
Is authorization required for individual therapy, or a referral from my provider?
Are there any exclusions, limitations, or other requirements I should be aware of for outpatient psychotherapy?
If your provider is not in-network with your plan, you still may have access to out of network benefits. Usually this involves submitting a superbill after paying for services, and getting reimbursed by your insurance. Here are some questions to ask your insurance about out of network mental health benefits.
Out of network benefit
A plan that includes out-of-network benefits is usually referred to as Preferred Provider Organization Plan (PPO) or Point-Of-Service Plan (POS).
What is my out-of-network deductible?
How much of my out-of-network deductible has already been met?
What is my out-of-pocket maximum?
Do my deductible, co-pays & co-insurance apply toward my OOP max?
How long do I have to submit my Superbill after a session?
What is the allowed amount/ reimbursement rate covered by my insurance for outpatient psychotherapy?