How to Know What Your Family’s Insurance Coversen Español
Mental health care is usually included in health insurance plans that cover your kids, but the specific benefits vary a lot depending on your insurance provider and plan. To get the most out of your family’s insurance and avoid unexpected costs, it’s important to figure out exactly what your plan covers before your child gets care.
Getting information from the insurance company
Because insurance plans are often complicated, the best way to find out exactly what yours covers is to talk with a representative from the company. You can do this by calling the phone number on your insurance card or sometimes by contacting a representative through the company’s online portal.
Make sure you have your insurance card with you when you call, since you’ll need the information on it to find out more about your plan.
If you have already been in touch with a provider, they may also be able to give you a code for the treatment your child will get. This code is called a CPT (current procedural terminology) code. It is a series of numbers linked to a specific treatment, like an individual psychotherapy session. If you have a CPT code from your provider, you can ask the insurance company how much of the cost they would cover for that specific treatment.
If you’re trying to find out if a specific provider is in-network with your insurance, have their full first and last name ready as well. You can also ask your provider what their NPI is. NPI stands for “national provider identifier” and it’s a way of identifying a health care provider. Having the NPI on hand helps you make sure that you and your insurance company are talking about the same provider, rather than someone else with the same name.
Questions to ask
The goal of talking to the insurance company is to find out everything you can about what your family’s insurance plan covers, how payment works, and how much of the cost of treatment you would be responsible for. It helps to write down all your questions ahead of time. Here are some of the questions you can ask:
- Does my child’s plan include in-network mental or behavioral health care? How about out-of-network benefits?
- Does my child need a diagnosis in order for their treatment to be covered? If so, which diagnoses are covered?
- Does my child need a referral from their doctor before seeing a mental or behavioral health care specialist?
- Does the insurance company require pre-approval in order to pay for care?
- What is my copay for my child’s in-network care? How about out-of-network care?
- Has my deductible been met for this year? If not, how much more do I need to pay before it is met?
- If you have a CPT code: What is the allowable amount for this code?
- Is there a limit on how many visits my child’s insurance will cover? What about dollar limits or any other limits on coverage?
- Does my child’s plan cover the cost of medications for mental health concerns? Are there copays for medications?
Who else can help
If you’re confused by trying to sort out your child’s insurance coverage, you’re not alone! If you’re still unsure about how much your child’s care will cost you, talking to your provider can help. They may be able to check your benefits or help you figure out what further information you need from the insurance company.
If you have insurance through your employer, someone at your job may also be able to help or put you in touch with a dedicated representative from the insurance company.
Finally, remember that using insurance isn’t the only affordable way to find mental health care for kids. If your benefits don’t cover the care your child needs, you can also look for free or low-cost care through local clinics, non-profits, community centers or medical schools.
Return to Connect to Care for more information about getting kids help.