Questions for your Insurance Provider:

1. Do you have out-of-network benefits for mental health?

2. If so, how many sessions will they cover per year?

3. What is your deductible and is it separate from your other health benefits deductible?  (Deductible is the amount the insurance company asks that you pay towards your out-of-network health care. After you have paid out this amount, they will cover a portion of the rest of your expenses.) 

Sometimes they have a separate deductible for mental health services, so it is best to ask about this.

4. What is their usual and customary payment for an individual psychotherapy session, CPT code 90834? (CPT code 90834 is the procedure code for a 38 to 52 minute psychotherapy session.) Providers are sometimes reluctant to give out this number. If so, ask if they can give you a range.

5. Do they base your payments towards your deductible on the total of the fee you pay, or only on the amount that they consider usual and customary? In other words, if their usual and customary rate is $70 per session, then only $70 of each session you pay for will count towards paying down your deductible, even if you are paying $100 per session out-of-pocket.

6. What percentage of each session will they pay? Insurance companies tend to only pay for a percentage of their usual and customary rate  when you use someone from out-of-network. For instance, if their customary fee is $100 and they pay 50% of this fee for out-of-network services, then they will reimburse you $50 per session, whether you pay $100 or $200 to your therapist.

7. Is your plan year, the period of time that the deductible is good for,  the same as the calendar year?