Contacting Your Insurance Company: What to Know Before You Call

by Hannah Lane, Clinical Care Coordinator

Calling your insurance company can be a stressful experience – especially if you’re having a hard time coming up with the right questions to ask. Sometimes, it can seem easier to put off calling at all! We know how important it is for you to understand your coverage, and we want to help you get the most out of your phone call with your insurance representative.

General Calling Tips

Before coming in for your first appointment, or if you have had any recent insurance changes, it’s a good idea to check in about what your coverage looks like to avoid any surprises once you receive your first claim back from your insurance. You can find the member services number for your insurance provider on the front or back of your insurance card. You’ll also want to make sure you have your card with you when you call, since you’ll probably need your member ID number.

Even if you have a good idea of what your coverage looks like when you see your primary care provider, it’s good to call your insurance when seeking out a new service. Sometimes, mental health coverage can look different than your physical health coverage, and it’s important to be aware of your copay, coinsurance percentage, or your deductible amount for you to be able to get a more accurate idea of your own out of pocket costs.

Pro Tip: Whether you’re calling to ask about your general coverage or about a specific claim, it’s always a good idea to ask for the name of the representative you’re speaking with, as well as any identifying call number information that they can give you. Some insurance companies do assign numbers to their incoming calls, but some do not, so if a name is all that you can get, not to worry! You can always note down the day and approximate time of your call so that you can refer back to it with another representative if needed.

If you’re calling to ask about your mental health coverage, here are some example questions that you can ask to get the information that you need:

• Does my insurance plan offer mental health coverage? (If asked for specifics, you can let them know that you are looking for information on your coverage for outpatient mental health in an office setting.)
• Am I responsible for a copay amount, or do my sessions go towards my deductible until it’s met?
• Do I have a separate deductible for mental health coverage, or is it all the same?
• Will I be responsible for a percentage of the cost once my deductible is met?

Asking About Specific Services

Are you interested in doing telehealth with your provider? Thinking about attending some couples sessions with your partner? If you’re interested in a service that isn’t a one on one, in-office session, it’s also a good idea to reach out to your insurance to ask about what your coverage looks like for specific services. Some plans may offer coverage for individual counseling, but not for couples or families, and some plans may offer coverage for in-person services, but not for anything done via telehealth. Once you know what your plan covers, you can make an informed decision about what kind of appointment works best for you.

If you’re calling to ask about a specific service being covered by your mental health plan, here are some example questions you can ask:

• Do I have coverage for telehealth sessions through my provider’s office?
• Does telehealth have to be offered over a certain platform for there to be coverage?
• Do I have coverage for couples’/family sessions like I do for my individual sessions?
• Are there any limitations or restrictions on my coverage for couples’/family sessions?

Scheduling Tips

Many insurance policies do not offer coverage for couples’ sessions, or they may only offer coverage for couples’ sessions that meet very specific criteria. We have found that most of the sessions we have at the office do not meet this very specific criteria, which that even though your plan may have coverage for couples sessions, it’s a good idea to ask if there are any limitations on this coverage, including specific diagnoses.

Most insurance companies will only offer coverage for one session per week. If you would like to be seen more often, please speak with your provider first, and then reach out to your insurance company to confirm coverage.

If you are being seen for both couples’ and individual sessions, even if you are being seen at a different office for one of the services, we recommend scheduling your appointments on different days. The same is true if you see a provider for medication management. Sometimes, insurance will reject one of two claims received for similar services on the same day. The easiest way to avoid this is to schedule your appointments on different days of the week when possible.

Insurance and Our Office

We will bill your insurance for you after each session, although the turnaround time for claims can vary between a week and several months, depending on your insurance and how fast they are currently able to process their volume of claims.

We aren’t able to verify your insurance benefits on your behalf, however, and we encourage all clients to reach out to their insurance about their coverage before their first appointment with us. 

If you have any questions about what your insurance has let you know about your coverage, we are happy to talk with you about what this means for you, your session coverage, and your patient responsibility at any time!