Mental health care is often included in the health insurance plans that cover your children, but the specific benefits vary greatly depending on the insurance provider and plan. To get the most out of your family’s insurance and avoid unexpected costs, it’s important to find out exactly what your plan covers before your child receives medical care.
Since insurance plans are often complicated, the best way to find out exactly what yours covers is to speak with a company representative. You can do this by calling the phone number on the back of 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, as you will need the information on it to learn more about your plan.
If you have already contacted a provider, they may also be able to give you a code for the treatment your child will receive. This code is called the CPT (Current Procedural Terminology) code. This is a series of numbers linked to a specific treatment, such as an individual psychotherapy session. If you have a CPT code from your provider, you can ask the insurance company how much of the cost that specific treatment would cover.
If you want to know if a specific provider is within your insurance network, please also have their full name and surname available. You can also ask your provider for their NPI. NPI stands for “national provider identifier” and is a way of identifying a health care provider. Having the NPI handy helps you make sure that you and your insurance company are talking about the same provider and not another with the same name.
The goal of speaking with the insurance company is to find out as much as you can about what your family’s insurance plan covers, how the payment works, and how much of the cost of treatment would be yours. It can be helpful to write down all the questions in advance. These are some of the questions you can ask:
- Does my child’s plan include in-network behavioral or mental health care? What about out-of-network benefits?
- Does my child need a diagnosis for their treatment to be covered? If yes, what diagnoses are covered?
- Does my child need a referral from their doctor before seeing a behavioral or mental health specialist?
- Does the insurance company require pre-approval to pay for care?
- What is the copayment for my child’s in-network care? What about out-of-network care?
- Have I already paid this year’s deductible? If not, how much more do I have to pay before it is fulfilled?
- If you have a CPT code: What is the allowed quantity for this code?
- Is there a limit to the number of visits my child’s insurance covers? What about dollar limits or any other limits on coverage?
- Does my child’s plan cover the cost of medicines for mental health problems? Are there copays for medications?
If you are confused when trying to figure out your child’s insurance coverage, you are not alone! If you’re still not sure how much your child’s care will cost, talking with your provider can help. They may be able to check your benefits or help you find out what additional information you need from the insurance company.
If you have insurance through your company, someone at work may be able to help you or put you in touch with a representative from the insurance company.
Lastly, remember that using insurance is not the only affordable way to find mental health care for children. If your benefits do not cover the care your child needs, you can also seek free or low-cost care through local clinics, nonprofits, community centers, or medical schools.