I am in-network with Anthem/BCBS. All plans are different, so you'll need to call them and ask what your copay and deductible are, and any other questions you need to know. Check the back of your insurance card for the "Member Services" or "Customer Service" phone number. Ask them:
Is Margaret Howard, LCSW in network for me? What is my copay for mental health? What is my deductible? How much of my deductible has been met?
Out-of-Network benefits for all other insurance plans: When using an insurance other than Anthem BCBS you will pay at time of session then submit to your insurance company yourself for reimbursement. You will likely want to know what percentage they will reimburse you for.
Call the number on the back of your insurance card for the Benefits Department, Member Services, or Customer Service and ask them the following questions, and any other question you need to know*: Ask These Questions: 1) What is your name and extension number? ___________________________
2) Does my policy cover Out-of-Network, Licensed Clinical Social Workers? ___yes ___no
3) My therapist is willing to provide a statement of Session Dates Attended, the CPT code, and the Diagnosis. Is this acceptable to the insurance company? ___yes ___no
4) Does my policy cover Individual Psychotherapy? (CPT code 90837) ___yes ___no
5) What mental health Diagnoses are NOT reimbursable? ____________________________
6) How many Sessions are covered per year? _______
7) What is the Lifetime Maximum for mental health benefits? $_____________
8) What is my Out-of-Network Deductible? $_________
9) What is the Allowed Amount of the fee? a. Individual session (My fee is $120, CPT code is 90837): $______ Many insurance companies will reimburse a percentage of the total fee paid. In order to know how much of the $120 fee you’ll be reimbursed you’ll need to know what that percentage is. Some plans reimburse 80 percent, some 50 percent, etc. Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number.
10) What percent of the Allowed Amount will be reimbursed? _______%
11) How do I file a claim? ______________________________________________________
Write down every answer you receive. Ask for explanations of anything you don't understand. Ask to speak to a supervisor if you are not happy with the answers you are getting. You'll need careful records later if the company fails to follow through with what they've told you.
*Please note that I am not an insurance expert; these are the questions that need to be asked, to the best of my understanding. However, you are encouraged to do your own research, and I am not liable in any way if this information does not tell you what you need to know.
This handy form has all of the above questions about out-of-network benefits, and more: