Understanding psychotherapy coverage within your insurance plan

Some insurance plans will reimburse 80% of the session fee, whereas others prefer you to stay in-network. Some plans require you to meet an out-of-pocket minimum prior to reimbursement or have a specific number of sessions permitted. To get more specific details, you can call your insurance company and ask some questions.

Here are some Questions that may prove useful in your conversation with your insurance company about psychotherapy coverage and your insurance plan:

1. How much is covered for each individual therapy session with an out-of-network psychologist with a PsyD?  Provide CPT code 90834 (45-minute in-person psychotherapy session) and 90834-95 (45-minute individual psychotherapy session conducted via telehealth) to get specific information about your plan’s coverage for therapy. You’ll get a dollar ($) amount or a percentage (%) amount.

2. What is your insurance plan deductible?

3. How many visits or sessions will be covered during what duration?

4. When does my insurance plan start and renew?

5. How much of my deductible has been met thus far?

6. Does my plan offer Telehealth/telepsychology coverage (specifically CPT code 90834-95)?

7. How do I submit a statement of reimbursement (aka superbill)?