Blue Water

Calling Your health insurance to determine your coverage for therapy

As your mental health provider, our billing department is happy to do a courtesy benefits check for you regarding your mental health coverage. Insurance gives us access to your benefits information most of the time through dedicated provider portals. However, some plans do not provide us information and require the customer to call to verify their insurance coverage. When that is the case, you can use this script below as a guide. 

Script

Before you make a phone call to your insurance,  you will need to provide your first name, last name, date of birth and Member ID on your insurance card.

 

1) Look on the back of your insurance card for the “customer service” or “member services” number. Sometimes there is a separate number for Mental Health.

 

 2) Once you call – you would select the prompt for “benefits verification” or “eligibility”.

 

3) Once you are speaking with a representative, tell them you would like to know what your outpatient mental health benefits are and ask the following questions:

 

  • Is Cityscape Counseling or “therapist name” an in-network provider? (We are usually in network for any Blue Cross PPO plan, Blue Choice, Aetna, Cigna or United Health Care/Optum/UMR/UPMC plans)

 

  • Are my mental health benefits with the same insurance provider as my medical benefits or are they carved out to a different insurance company? If yes, which insurance company are my mental health benefits covered by?

 

  • Do I have a deductible and does it apply to the following CPT codes 90791 and 90837 (90834 for United health care as they do not cover 90837).

 

  • If I do have a deductible that applies, how much of my deductible has been met and how much do I still owe?

 

  • Do I have a copay or co-insurance? How much is it and does deductible have to be met before the copay or co-insurance applies?

 

  • What is my out of pocket maximum and how much more do I still need to meet? (Usually once this is met, services are covered at 100%)

 

  • Can I have a reference number for this call?

Please note: ALL INSURANCE BENEFITS QUOTES ARE NOT A GUARANTEE OF PAYMENT. BENEFIT AND ELIGIBILITY REPORTS FROM YOUR INSURANCE ARE SUBJECT TO ALL CONTRACT LIMITATIONS AND YOUR ELIGIBILITY STATUS ON THE DATE OF SERVICE. ACCUMULATED AMOUNTS SUCH AS DEDUCTIBLE MAY CHANGE AS ADDITIONAL CLAIMS ARE PROCESSED. YOU ARE STILL RESPONSIBLE FOR THE PAYMENT OF YOUR VISIT IF IT IS DENIED BY YOUR INSURANCE.