Communicating with your insurance company:

First Steps:

1.  Make sure you are calling the correct number.  You must dial the number    for Mental Health/Substance Abuse or Behavioral Health.  If there is not a separate number for mental health, then specify that you are calling for Mental Health Benefits when calling the general number.

2.  Make note of the date and time of the call, the name of the insurance representative, their phone number and extension.

Filing Information:

1.  Insurance mailing address to file claim

2.  Insurance online address to file claim

Benefits Information:

1.   Are eating disorders covered in this policy? 

2.   Diagnosis codes:

a.     Anorexia Nervosa: 307.1

b.     Bulimia Nervosa: 307.51

c.     Eating Disorder Not Otherwise Specified: 307.50

3.     Do I have out of network benefits for mental health services?

a.     Is pre-certification required?

b.     What steps do I take to get pre-certified?

4.     Do I have psychiatric inpatient hospitalization coverage?

5.     If residential treatment is necessary, do I have coverage?

6.     What is the lifetime maximum benefit for mental health services?

7.     What is the annual maximum benefit for mental health services?

 
Co-Pay/Deductible Information:

     1.     *What is my co-payment?  (Please refer below for explanation of UCR)

2.     Is there a deductible, and if so, what is the amount?

3.     If the provider is out of network, what is the co-pay and deductible?

4.     What percentage of my annual deductible have I met so far this year?

5.     Is there a weekly or annual limit to how many sessions are covered?

*UCR:  Usual, Customary, and Reasonable fees.  This is a term health insurance companies use to determine how much of the claim they will pay.  You may not know the exact amount the insurance will cover until the first claim is filed.  Discuss this with the therapist.