How to Check Your Insurance Benefits for Therapy
How to Check Your Insurance Benefits for Therapy: Understanding your insurance coverage can feel confusing, especially when it comes to therapy. This guide will walk you through the steps to check your benefits, so you know what’s covered and what your out-of-pocket costs might be.
How to Check Your Insurance Benefits for Therapy
Understanding your insurance coverage can feel confusing, especially when it comes to therapy. This guide will walk you through the steps to check your benefits, so you know what’s covered and what your out-of-pocket costs might be.
Step 1: Gather Your Insurance Information
Before checking your benefits, have your insurance card handy. Key details to note:
Member ID
Group number (if applicable)
Customer service phone number
Plan type (HMO, PPO, etc.)
Step 2: Check Online
Most insurance companies have member portals or apps where you can view benefits, deductibles, and coverage limits. Look for sections labeled “Benefits,” “Coverage,” or “Behavioral Health/Mental Health Services.”
Common portals include:
Oregon Health Plan (OHP): OHP Member Services Portal – check coverage and approved providers.
Private insurance providers (examples): Blue Cross/Blue Shield, UnitedHealthcare, Cigna, Aetna, Kaiser, Humana. Most have online portals where you can check out-of-network coverage and preauthorization requirements.
Step 3: Call Your Insurance Company
Even if you check online, it’s a good idea to call your insurance provider. Ask:
Do I have out-of-network mental health benefits?
What is my deductible and has it been met?
What percentage of therapy sessions are reimbursed?
Are there session limits or caps?
Is preauthorization required?
How do I submit an out-of-network claim?
Step 4: Understand Preauthorization
Some insurance plans require preauthorization before therapy sessions are covered. This is a review process to confirm coverage, the number of sessions, and potential costs. Preauthorizations usually take a few days to a couple of weeks.
Step 5: Using a Superbill
If you are seeing me as an out-of-network provider, I can provide a superbill, which is a detailed receipt for each session. You can submit this to your insurance company for partial reimbursement.
Step 6: Using FSA or HSA Funds
If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), therapy sessions may be eligible for reimbursement. You can pay for sessions directly with these accounts or submit your superbill for reimbursement later.
Step 7: Notes About OHP, Out-of-State, and Out-of-Network Coverage
I accept Oregon Health Plan (OHP) but do not take CareOregon.
For clients in other states, such as Florida or Idaho, I am not contracted with insurance companies yet. Some larger insurers may still reimburse for out-of-network therapy.
We can also use a prior authorization check to see if your sessions will be covered.
Tips for a Smooth Insurance Check
Keep a log of the call: note the date, agent name, and what they told you.
Ask for any forms or claim submission instructions while you’re on the call.
Remember that coverage can change yearly; check again if your plan renews.
Don’t worry if things feel confusing — I can help guide you through submitting superbills or checking prior authorization if needed.
Insurance Benefits Checklist
Use this checklist to make sure you’ve covered everything before your first session:
☐ Gather your insurance card (member ID, group number, plan type, customer service number)
☐ Log in to your insurance portal or app
☐ Check for out-of-network mental health benefits
☐ Check your deductible and out-of-pocket maximum
☐ Check session limits or caps
☐ Confirm if preauthorization is required
☐ Ask how to submit out-of-network claims
☐ Save the call notes (agent name, date, details)
☐ Keep your superbill for reimbursement
☐ Check FSA/HSA eligibility