What should I ask my insurance provider about my visit costs?

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What should I ask my insurance provider about my visit costs?

The best way to get a clear, accurate estimate of your out-of-pocket costs is to contact your insurance provider directly. Here’s what to ask them:

• Do I have mental health benefits that include outpatient psychiatry?
• Is Talkiatry in-network for my plan?
• What’s my copay or coinsurance for outpatient psychiatry visits?
• Do I have a deductible? If so, how close am I to meeting it?
• Do I have an out-of-pocket maximum? If so, how close am I to reaching it?
• Are virtual or telehealth psychiatry visits covered the same as in-person care?
• Is prior authorization required for outpatient psychiatry?
• Can you provide a cost estimate for an in-network psychiatry visit using CPT code 99204?
• Can you provide a cost estimate for an in-network psychotherapy visit using CPT code 90833?

Here’s a brief overview of common insurance terms to guide your conversation.

• Coinsurance: a percentage of the visit cost you're responsible for after your deductible is met
• Deductible: the amount you must pay out-of-pocket before insurance starts covering care
• Out-of-network: clinicians or practices that don't have a contract with your plan
• Copay: a fixed dollar amount you pay for a visit
• Explanation of benefits: a document from your insurance company outlining what they paid, what they didn't, and what you might owe.
• CPT Code: a standardized code for the healthcare services you received, which insurance companies use to process and price your visits.
• In-network: a clinician or practice that has a contract with your insurance plan to offer services at a negotiated rate—like Talkiatry.
• Out-of-pocket maximum: the most you'll pay in a year before your insurance covers 100% of covered services, including copays, coinsurance, and your deductible