using insurance

If you are intending to use your health insurance to help cover the costs of your therapy, you may want to check into the specifics of your coverage before you begin. Every insurance company and plan is different. Some will exclude certain types of sessions (e.g. couples counseling) and even certain diagnoses. Some may restrict the session length to a 45-minute session rather than a full 60-minute session. It’s important for you to check into your plan’s benefits so you know upfront what is covered.

Here are a few questions to ask your insurance company about your coverage:

  1. Does my health plan cover outpatient mental health counseling from a Licensed Mental Health Counselor (LMHC)?
  2. Is my counselor, Phil Prothero, LMHC, a contracted provider? (This will determine if coverage will be under your in-network or out-of-network plan benefit.)
  3. Do I need a referral from my primary care physician or a pre-authorization before starting counseling?
  4. Does my deductible apply before services are covered? If yes, how much is remaining to be paid toward the deductible?
  5. Does my plan require a co-pay? If yes, what is the co-pay?
  6. How much of the counseling session fee is covered? This is what is called your co-insurance.
  7. Is there a limit to the number of sessions in a calendar year? Or a dollar limit to what is covered per year?
  8. Is there a limit on duration of session (45 minutes vs. 60 minutes)?
  9. What types of psychotherapy services are covered?
  • Individual counseling?
    • 45-minute psychotherapy session, CPT code: 90834
    • 60-minute psychotherapy session, CPT code: 90837
  • Couples counseling, CPT code: 90847
  • Group counseling, CPT code: 90853

If I am a contracted provider with your insurance company, I will also verify your benefits and discuss them with you. Even though your insurance company may quote certain benefits, I cannot guarantee they will actually cover our work together and thus you may be responsible for paying for the services not covered by your insurance company.

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