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TherapyExplained

Insurance Benefits Verification Worksheet

Before your first therapy session, call the number on the back of your insurance card. Use this worksheet to record your benefits so you know exactly what therapy will cost.

Have your insurance card handy— you will need your member ID and group number. The customer service number is usually on the back of your card.

1. Your Insurance Information

Fill these in from your card or while on the call.

2. Questions to Ask Your Insurance Company

Read each question aloud to the representative and record their answer.

1

“Do I have outpatient mental health benefits?”

This confirms your plan actually covers therapy. Some older or limited plans exclude mental health.
2

“Is there a separate deductible for mental health?”

Some plans have a separate behavioral-health deductible in addition to the medical deductible.
3

“What is my in-network deductible for mental health?”

The deductible is the amount you pay out-of-pocket before insurance starts covering sessions.
$
4

“How much of my deductible have I met this year?”

If you have already met part of your deductible, you may start getting coverage sooner.
$
5

“What is my in-network copay or coinsurance for outpatient mental health?”

After meeting your deductible, this is your per-session cost. A copay is a flat dollar amount; coinsurance is a percentage of the allowed charge.
6

“Is there a limit on the number of sessions per year?”

Some plans cap the number of therapy visits per calendar or plan year.
7

“Do I need prior authorization or a referral?”

Some plans (especially HMOs) require your primary care doctor to submit a referral, or the insurer to pre-approve sessions.
8

“Do I have out-of-network mental health benefits?”

Out-of-network benefits let you see any licensed therapist, not just those in your plan’s network. PPO and POS plans typically include OON benefits; HMOs usually do not.
9

“What is my out-of-network deductible?”

The OON deductible is usually higher than in-network. You pay this before the plan reimburses anything.
$
10

“How much of my out-of-network deductible have I met?”

Knowing what you have already paid helps estimate when reimbursement kicks in.
$
11

“What is my out-of-network coinsurance rate?”

After meeting the OON deductible, insurance pays this percentage of the allowed amount. Common rates are 50–80%.
%
12

“What is the ‘allowed amount’ or ‘usual and customary rate’ for CPT code 90837 (60-minute therapy session)?”

Insurance reimburses based on this amount, not the therapist’s actual fee. The difference comes out of your pocket.
$
13

“Is telehealth covered at the same rate as in-person?”

Some plans have different copays or restrictions for virtual sessions.
14

“Is couples or family therapy covered?”

Not all plans cover couples or family therapy, and some require a specific diagnosis to be eligible.
15

“How do I submit out-of-network claims/superbills?”

You’ll need to know the portal URL, fax number, or mailing address to submit claims for reimbursement.

3. Your Benefits Summary

Based on what you have recorded:

Estimated in-network cost per session
—
Estimated out-of-network cost per session
—
In-network deductible remaining
—
Annual session limit
—
Authorization / referral needed
—

Related tools and guides

This worksheet is for personal reference only. Always verify information directly with your insurance provider.