FAQ

Questions to ask your insurance company about Out of Network Benefits

Look at the back of your health insurance card, there should be a phone number that indicates Mental Health benefits or Employee Assistance Program (EAP). Call the number and ask for the Benefits Department. Ask the following questions and don't be afraid to ask for more clarification if needed. Take notes and ask for names of the people assisting you. Ask to
speak to a supervisor if you are not happy with the answers you are getting.

#1. Does my plan cover Out of Network Licensed Clinical Social Workers?

#2. My therapist is willing to provide a statement including Session Dates Attended, the CPT

code, and the Diagnosis. Is this acceptable to the insurance company? _yes _no

#3. Does my policy cover:

Individual Psychotherapy? (CPT code 90837) _yes_no

Group Psychotherapy? (CPT code 90853) _yes _no

#4. What mental health Diagnoses are NOT reimbursable?

#5. How many Sessions are covered per year?

#6. What is the Lifetime Maximum for mental health benefits?

#7. What is my Out-of-Network Deductible?

#8.         What is the Allowed Amount of the fee?
               a. Individual session (My fee is $135, CPT code is 90837): $
               b. Group session (My fee is $60, CPT code is 90853): $_
                  Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may

reimburse you 80% of the total fee paid, or $108. Other companies will substitute the $135 fee for what they

deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you

80% of the “allowed amount” of the fee. You paid $135 for an individual session, but your insurance company

only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this

information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your

medical expense budget without this number.

#9. What percent of the Allowed Amount will be reimbursed?

#10. How do I file a claim?

Important Considerations

o At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit.
o In January of each year, you will not get any money back until your deductible is met. If you apply other family medical

expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.
o Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited. Your out-of-

pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."

o Ask your accountant about taking a medical tax deduction for psychotherapy.

o You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network
therapy (called Preferred Provider Organization, or PPO).

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Therapy St. Louis

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Questions to ask your insurance company about Out of Network Benefits

#1. Does my plan cover Out of Network Licensed Clinical Social Workers?

#2. My therapist is willing to provide a statement including Session Dates Attended, the CPT

code, and the Diagnosis. Is this acceptable to the insurance company? _yes _no

#3. Does my policy cover:

Individual Psychotherapy? (CPT code 90837) _yes_no

Group Psychotherapy? (CPT code 90853) _yes _no

#4. What mental health Diagnoses are NOT reimbursable?

#5. How many Sessions are covered per year?

#6. What is the Lifetime Maximum for mental health benefits?

#7. What is my Out-of-Network Deductible?

reimburse you 80% of the total fee paid, or $108. Other companies will substitute the $135 fee for what they

deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you

80% of the “allowed amount” of the fee. You paid $135 for an individual session, but your insurance company

only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this

information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your

medical expense budget without this number.

#9. What percent of the Allowed Amount will be reimbursed?

#10. How do I file a claim?

Important Considerations

o At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit.
o In January of each year, you will not get any money back until your deductible is met. If you apply other family medical

expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.
o Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited. Your out-of-

pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."

o Ask your accountant about taking a medical tax deduction for psychotherapy.

o You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network
therapy (called Preferred Provider Organization, or PPO).

Sage Tree Therapy

Questions to ask your insurance company about Out of Network Benefits

#1. Does my plan cover Out of Network Licensed Clinical Social Workers?

​

#2. My therapist is willing to provide a statement including Session Dates Attended, the CPT

code, and the Diagnosis. Is this acceptable to the insurance company? ___yes ___no

​

#3. Does my policy cover:

Individual Psychotherapy? (CPT code 90837) ___yes___no

Group Psychotherapy? (CPT code 90853) ___yes ___no

​

#4. What mental health Diagnoses are NOT reimbursable?

#5. How many Sessions are covered per year?

#6. What is the Lifetime Maximum for mental health benefits?

#7. What is my Out-of-Network Deductible?

#8. What is the Allowed Amount of the fee? a. Individual session (My fee is $135, CPT code is 90837): $______ b. Group session (My fee is $60, CPT code is 90853): $_______ Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may

reimburse you 80% of the total fee paid, or $108. Other companies will substitute the $135 fee for what they

deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you

80% of the “allowed amount” of the fee. You paid $135 for an individual session, but your insurance company

only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this

information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your

​ medical expense budget without this number.

​ #9. What percent of the Allowed Amount will be reimbursed?

#10. How do I file a claim?

​Important Considerations

​ o At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit. o In January of each year, you will not get any money back until your deductible is met. If you apply other family medical

expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for. o Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited. Your out-of-

pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."

o Ask your accountant about taking a medical tax deduction for psychotherapy.

o You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network therapy (called Preferred Provider Organization, or PPO).

Sage Tree Therapy

code, and the Diagnosis. Is this acceptable to the insurance company? _yes _no

Individual Psychotherapy? (CPT code 90837) _yes_no

Group Psychotherapy? (CPT code 90853) _yes _no

#8. What is the Allowed Amount of the fee?
a. Individual session (My fee is $135, CPT code is 90837): $
b. Group session (My fee is $60, CPT code is 90853): $_
Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may

medical expense budget without this number.

#9. What percent of the Allowed Amount will be reimbursed?

Important Considerations

o At the beginning of your therapy, there will be a wait until your insurance company begins to pay your benefit.
o In January of each year, you will not get any money back until your deductible is met. If you apply other family medical

expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.
o Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited. Your out-of-

o You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network
therapy (called Preferred Provider Organization, or PPO).