INSURANCE

1. Call your health insurance provider. This number is usually on the back of your health insurance card. 

2. Ask whether you have out-of-network benefits specifically for mental health. If the answer is “no”, and you have health insurance through your employer, consider asking your employer if they offer other health insurance plans with out-of-network benefits for mental health — or if they plan to do so in the future. Sometimes employers are willing to expand the plans that they offer to their employees.

3. Ask whether you need pre-authorization for psychotherapy. 

4. Ask whether you have an annual out-of-network mental health deductible. If so, ask how much it is and how much of it has been met so far. Ask what the policy year is (for example: January 1 – December 31), so that you can calculate when your annual out-of-network mental health deductible restarts.

5. Ask what percentage your health insurance provider will cover per mental health session once they begin reimbursing you (i.e. once you meet your annual out-of-network mental health deductible). You can also ask what your co-insurance is.

6. Ask if they cover Clinical Procedure Terminology (CPT) code 90834. This is the medical code we bill under for the service of ongoing individual psychotherapy.

7. Ask what the maximum $ amount per mental health session is that they consider reasonable and customary. This is the amount that your health insurance plan determines is the normal range of payment within a given geographic area. Sometimes, it's $100, which means that they reimburse a percent of $100; other times, it's much higher, which means that they will cover more. They may not answer this question, because they often don't like to give out this information.

8. Ask how many mental health sessions per year are covered. Sometimes, it's unlimited.

9. Ask how you get reimbursed / submit a claim for reimbursement. Ask how many days it takes for the claim for reimbursement to be processed and for the reimbursement to be sent to you. Typically, it takes about a month.

10. Ask what your plan's annual out-of-network out-of-pocket maximum limit is — meaning, once you hit a certain $ amount of out-of-network out-of-pocket payments (for example: $2,000), you may be eligible for 100% reimbursement of out-of-network costs.

If they ask you for therapist information, you can share the below:

Alessandra Mikic, LCSW
NY License: 093812
NPI: 1700561198
Tax ID: 92-1254751
Clinical Procedure Terminology (CPT) code: 90834