Here’s an example of how this might play out":

1. You: "What are my out-of-network benefits for mental health services?"

Insurance Provider: "Your plan covers out-of-network therapy, but the specifics depend on your deductible and maximum reimbursement limits. You'll need to verify your plan details to understand your benefits."

Understanding your benefits is crucial, as some plans may cover a percentage of out-of-network services. You should always request a breakdown of their specific coverage.

2. You: If doing couples or family therapy-
Does “family psychotherapy” apply here? (CPT Treatment code 90847) 

Insurance Provider: “Coverage is typically provided when the primary purpose of the session is to address the patient's diagnosed mental health condition. It's important to note that certain diagnoses may not qualify for reimbursement under this code.”

Plans differ in coverage on this point and it can be useful to also ask if “pre-authorization” is required. It is also worth asking if couples/family therapy is still covered if you are already receiving individual therapy from another provider.

3. You: Is there a deductible that I need to meet first? If so, what amount of each session is applied to the deductible?

Insurance Provider: "Yes, your plan has a $1,000 annual deductible that must be met before any out-of-network claims are paid. From a $200 out-of-network psychotherapy session, $100 is applied towards your deductible.”

This information is important as it sets the initial cost you will be responsible for before insurance coverage kicks in. Note: this does not necessarily mean after 5 sessions ($1,000/$200 = 5 sessions) as some companies only apply a a certain amount to each session (i.e. $100). So, this person would pay $200 a session for 10 sessions (as $100 x 10 sessions satisfies the $1,000 deductible) and then begin receiving reimbursement.

4. You: "What percentage of the session cost will be reimbursed?"

Insurance Provider: "You can expect to be reimbursed 60% of the session cost, but this applies only after you've met your $1,000 deductible."

For example, if you pay $200 per session, you will receive $120 back after meeting your deductible. 

5. You: "Are there any limits on the number of sessions I can claim in a month/year?"

Insurance Provider: "There is no specific limit on the number of sessions you can claim, but you should check your annual maximum benefit limit."

Understanding the maximum benefit will inform you how many sessions you can afford in a year under your current plan.

6. You: What documentation do I need to submit for reimbursement? How do I submit the superbill for reimbursement?

Insurance Provider: "You'll need to submit a superbill from your therapist detailing the services provided, the date of service, and the diagnosis. You can submit your superbill online through our member portal or by mailing it to our claims department"

Providing clear documentation will expedite your reimbursement process. Knowing the submission process helps you to avoid potential delays in reimbursement.

7. You: What specific credentials or licensing does the therapist need to have for reimbursement?

Insurance Provider Response: "Your therapist must be licensed in California and have a valid license number included on the superbill."

All members of the Table Family Therapy team are Licensed clinicians in the state of California but some agencies employ AMFT (pre-licensed) clinicians or mental health coaches (unlicensed clinicians) so this is important to inquire about.

8. You: "How long does it typically take to process claims and receive reimbursement?"

Insurance Provider: "Most claims are processed within 4-6 weeks after submission."

This timeline allows you to anticipate when you will receive reimbursement checks.