Mental health insurance benefits checklist

• Confirm the clinician and practice are in networkAsk about the exact provider and service location, not only the insurance company logo.
• Confirm outpatient mental health benefits are activeAsk separately about therapy, psychiatric evaluation, and medication-management visits.
• Ask for the copay or coinsurance for each serviceBenefits may differ for therapy, psychiatry, in-person care, and telehealth.
• Check your deductible and remaining balanceAsk whether mental health visits are subject to the deductible before copays apply.
• Verify telehealth coverageConfirm coverage for visits delivered to your location in Texas or New Mexico.
• Ask whether a primary-care referral is requiredSome HMO and managed plans require a referral before specialty care.
• Ask whether prior authorization is requiredCheck separately for evaluations, therapy sessions, psychological testing, and medications.
• Ask about visit limits or medical-necessity reviewsConfirm whether the plan limits annual visits or requires review after a certain number.
• Request the call reference numberRecord the representative’s name, date, time, and reference number for your records.
• Request a good-faith cost estimate from the practiceInsurance quotes are not guarantees; the practice can estimate likely patient responsibility.

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