Using Your Insurance Coverage for Counseling in Houston, TX
Each individual insurance plan is different. Here's how to find out about your insurance plan's coverage and how to get reimbursed for your counseling sessions.
1. Locate your insurance card or insurance policy paperwork.
2. Do you have an HMO or a PPO plan?
This information should be listed on your insurance card. If you can't find it, you can call your insurance company and ask whether you have an HMO or PPO policy.
If you have an HMO policy...
You'll need to choose an "in-network" counseling provider to use your insurance coverage for counseling sessions. Your insurance company can give you a list of counselors that are in-network providers.
I'm considered an "out-of-network" provider, which means you won't be able to use your HMO insurance benefits to pay for our counseling sessions. You may decide to pay out-of-pocket for counseling sessions if you would like to work together.
If you have a PPO policy…
With a PPO policy, you can use your insurance benefits to work with any counselor you like - including me. If you'd like to use your insurance benefits for our counseling sessions, you'll pay at the time of service, and I'll provide you with a form to submit to your insurance company so that you can get reimbursed for all or part of the counseling session fee. The amount you'll be reimbursed for your counseling session depends on your individual insurance plan.
3. How can I find out how much I'll be reimbursed for counseling sessions?
To find out how much you'll be reimbursed for counseling sessions, you can call your insurance company and ask the following questions.
a. Do I have online counseling mental health benefits, and do I need pre-approval for counseling sessions?
Some insurance plans may require pre-approval for counseling sessions or may name a specific number of counseling sessions covered during a certain time frame.
b. What is my out-of-network deductible?
This lets you know how much money you need to spend out-of-network before your benefits kick in.
c. How much of my out-of-network deductible has already been met?
Knowing how much you've already spent will let you know how much more you need to spend to meet your out-of-network deductible and for your benefits to start. For example, if your out-of-network deductible is $1000 and you've already spent $750, you'll only need to spend $250 more before your out-of-network benefits start.
d. What is my policy year?
A "policy year" is the 12-month period when your policy is in effect. This lets you know how much time you have to meet your deductible and when your deductible will start over.
e. What is my coinsurance or coverage amount per counseling session?
This is the percentage amount you'll be reimbursed for each counseling session (after your out-of-network deductible is met). Let's say the fee is $200 per counseling session and you have a 60% coinsurance. This means your insurance company will reimburse you for 60% of the counseling session fee, which is $120. After reimbursement, your out-of-pocket cost for a single counseling session will be $80.
f. How do I get reimbursed for counseling sessions with an out-of-network provider?
For most insurance plans, you'll need to get a "superbill" from your counselor and submit this document to your insurance company. A superbill is a special receipt with information your insurance company will need to reimburse you for your counseling sessions. Your insurance company will tell you how they want you to submit this document and how long you'll have to do this.
All insurance plans are different. You can use this list of questions when calling your insurance company to determine the specifics of your individual plan and your coverage for counseling sessions.
4. I called my insurance company, but I'm still not sure I understand what all of this means and how to use insurance for my counseling sessions. What do I do now?
If you're not sure whether your insurance company will cover your counseling session fees, please contact me to schedule your free 15-minute phone consultation. I'll be happy to help you figure out your insurance benefits and how to use them for counseling sessions.