Most insurance cards have a phone number on the back of the card to inquire about behavioral health benefits. Questions that can help to guide this conversation are:

• Does my insurance plan include out-of-network telepsychology benefits?

• What is my out-of-network deductible, and what amount of it have I met?

• Once I meet my out-of-network deductible, what reimbursement can I expect per session? (Most plans will have co-insurance after you have met your deductible, which is a percentage of the "allowed amount" that your company will pay for a therapy session).

• What is the allowed amount for a 50-min telepsychology session with a psychologist?

  • Insurance claims are filed using CPT codes, and the ones relevant to our work would be 90791 for the initial intake session and 90834 for subsequent 50-min sessions.

  • If insurance asks about the manner through which telepsychology is offered, you can tell them that I use HIPAA-secure video platforms through SimplePractice and Psychology Today.

• Do I have an out-of-pocket maximum for the year? (If you have such a maximum, that is the amount at which insurance would then pay 100% of the allowed amount for any out-of-network services you receive that year).

• Do I need a referral from my primary care physician to begin therapy?

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Good Faith Estimates

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Due to the No Surprises Act, health care providers need to give clients who are paying for their own services an estimate of the bill for requested health care services. You may request a Good Faith Estimate prior to beginning therapy, which can be better personalized to you after an initial complimentary phone assessment; this estimate is not a contract for services and does not obligate you to initiate therapy. Should you instead choose to schedule an initial assessment appointment, the Good Faith Estimate will be provided after that appointment and getting more details about your presenting concerns and goals for treatment. 

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Importantly, the Good Faith Estimate is only an estimate, and many factors may affect the actual cost of therapy over time (e.g., new clinical issues and goals, homework compliance). I will let you know as soon as possible of any changes expected with regards to ongoing treatment (e.g., change in session frequency, diagnosis and treatment goal changes), and you will be provided with a new Good Faith Estimate.

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If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill via the Department of Health and Human Services (HHS). Make sure to save a copy of your Good Faith Estimate, as it may be needed if you choose to dispute your bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800/985.3059.

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