Self-Verifying Insurance
​Most health insurance plans include mental health and substance use treatment. Typically insurance cards limit information on them and don't include details about your benefits, copay or co-insurance amount, or if your mental healthcare is managed by a different company than the one showing on your card. Before you start, always confirm your coverage with your insurance provider before scheduling any appointments. This step ensures you won't face unexpected out-of-pocket expenses.
How to verify your insurance benefits and eligbility
01
Prepare for the call
02
Contact Insurance Provider
03
Document and communicate details
Steps to Self-Verify
01: Prepare for the Call
Before calling your insurance provider, gather the necessary information to verify your benefits. The goal is to confirm whether your provider and the services they offer are covered under your plan.
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Check Network Status: You will want to ask if the provider is "in-network." Our group practice bills using the Tax IDs and NPIs of the licensed clinicians so please give us a call to receive the specific NPIs and Tax IDs that would correspond with the provider you have scheduled your appointment with.
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Prior Authorization: Determine if prior authorization is needed for services.
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If using EAP benefits: Have your authorization letter and number ready.
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If not using EAP benefits: Be prepared with the CPT codes for services – 90791 (initial evaluation), 90837 (60-minute session), and 90834 (45-50-minute session).
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02: Contact Your Insurance Provider
Find the "Member Services" or "Customer Service" number on your insurance card, usually on the back. Have the following information ready:
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Insurance ID number
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Your name, date of birth, and Social Security number
For example, on a Cigna card, the customer service number is typically located at the bottom of the back side (#14 in the sample card image). Each plan has a unique layout, but you can generally use numbers labeled "Customer Service," "Member Service," or "Mental Health/Behavioral Health."
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03: Document and Communicate Details
Ask the following questions during your call and write down the responses, including the name of the representative and any reference numbers:​
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What is my copay for routine services? (you can use the CPT codes if you want to be certain)
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What is my coinsurance percentage?
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How many therapy sessions are covered per year?
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Can you confirm if my provider is in-network?
If the provider is not in-network. You can ask the following:
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Does my plan cover a portion of the cost before I meet my deductible?
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What does my plan cover after I meet my deductible?
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How much do I have left to reach my deductible?
