Health Insurance Verification Tips

Health Insurance Disclosure and Insurance Verification Tips

Over the past few years, there have been many changes in the health care insurance industry. For that reason it is important for you to be aware of your policy, limits of coverage, co-payment, coinsurance and your rights concerning the access your insurance company and their designated management companies have to information about you.

You are ultimately responsible for the cost of services provided even though it is understood that an insurance company or other third-party payer will be reimbursing all or part of the cost incurred. It is to your benefit, and recommended, that you contact your insurance company to make certain you are knowledgeable about what is and what is not covered under the category of “Outpatient Mental Health or Behavioral Health”.

It would be wise to ask questions similar to these—after first obtaining the name of the insurance representative you spoke with, their direct phone number, and the date and time you spoke with them. The following questions are designed so that you can easily take notes during your conversation:

  1. Do I need to obtain preauthorization before seeing a provider?
  2. What is the amount of the fee that is covered or reimbursed?
  3. How much is my co-payment?
  4. What is my deductible and has it been met this year?
  5. What is the maximum payable benefit over what period of time?
  6. Is there a limit to the number of sessions?
  7. What is the procedure for obtaining additional sessions if medically necessary?
  8. Must my provider be on your insurance panel to obtain reimbursement?
  9. What is the benefit for “out-of-network” providers?
  10. Besides individual therapy, are other types of therapy (couples, family, group) covered?
  11. What is the extent of information that may be required from my provider in order to authorize services or obtain reimbursement for services (e.g., diagnosis, symptoms, treatment plan)?
  12. Do I have a “co-insurance” payment due?



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