To check if your plan has outpatient mental healthcare benefits for therapists who are not in-network for your plan, here is a helpful script to help you verify if/what is covered.

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Hi, my name is [Your Name] , and I’m calling to check on my mental health benefits. I’d like to understand what coverage I have for outpatient mental health services with an out-of-network provider.

Could you help me confirm whether my plan covers therapy or counseling sessions with a provider who is not in your network?

(Wait for the representative to respond. Then continue with specific questions below.)

Great, thank you. I have a few questions to make sure I understand the details:

• What is the reimbursement rate for out-of-network mental health visits? (For example, what percentage do you cover?)

• Is there a separate deductible for out-of-network services? If so, how much is it and how much have I met so far?

• Is pre-authorization or a referral required to use my out-of-network benefits for outpatient mental health?

• How do I submit claims for reimbursement if I pay out of pocket?

• Are there any limits on the number of sessions per year or restrictions on provider credentials (for example, LMFT, LPC, PhD psychologist)?

• What is the usual turnaround time for reimbursement once I submit a claim?

Just to confirm, can you tell me what the CPT codes would be for outpatient therapy reimbursement under my plan? I believe individual therapy is usually 90834 or 90837, and couples therapy is 90847—is that right?

Finally, is there anything else I should know before seeing an out-of-network mental health provider to make sure I can use my benefits properly?

(When finished)

Thank you so much for your help. Could you please send me this information in writing, or tell me where I can find it on my member portal?