You can contact your insurance company directly (using the number on the back of your card) and ask whether your plan includes out-of-network benefits for outpatient mental health therapy in an office setting. Coverage for these services varies widely by plan.

Ask your insurance representative if your plan includes a deductible for outpatient mental health therapy (office visits), specifically for out-of-network services. A deductible is the amount you must pay out-of-pocket before your insurance begins to reimburse for services. Deductible requirements are entirely dependent on your specific plan.

Your insurance company can provide the exact dollar amount of your out-of-network deductible for outpatient mental health services. Be sure to clarify whether this is an individual or family deductible, as amounts can vary significantly between plans.

Ask your insurance company how much of your deductible has already been met this year through other medical or outpatient mental health services. This will help you understand your remaining out-of-pocket responsibility, which varies by plan and prior claims activity.

You can ask your insurance provider what percentage of the “allowed amount” they reimburse for outpatient mental health therapy in an office setting under CPT codes 90791 and 90837. Reimbursement rates are completely plan-dependent and can vary widely, even within the same insurance company.

It’s also helpful to ask:

• How they determine the allowed amount (e.g., usual, customary, and reasonable rate)

Reimbursement for out-of-network services is typically sent directly to you, the client, not to the provider

We are in-network with most Independent Health plans in Western New York. However, it is still important to confirm with your insurance company that our specific provider is in-network under your plan, as participation can vary.

Ask your insurance representative if your plan includes a deductible for outpatient mental health therapy in an office setting.

• Some plans require a deductible before coverage begins; others only require a copay or coinsurance.

• Your insurance company can provide the exact amount of your deductible and let you know how much, if any, has already been met through other medical or mental health services this year.

Deductible requirements and amounts are completely plan-dependent and can vary significantly between plans.

Ask your insurance provider what your copay or coinsurance will be for outpatient mental health therapy in an office setting.

• A copay is a fixed amount you pay per session

• Coinsurance is a percentage of the cost after any deductible is met

These amounts are completely plan-dependent and can vary significantly, even within Independent Health.

We submit claims directly to Independent Health on your behalf. You are responsible only for your copay, coinsurance, or deductible as determined by your specific plan.

It can take up to six (6) weeks from the time of claim submission for Independent Health to send us information on your coverage, copays, and deductibles. You may not be charged for your copays during this time, but once the information is received, you may be back-charged for any outstanding amounts. After this initial period, copays and coinsurance will be charged at the time of service.