Understanding Your In-Network Insurance Benefits
The first step to navigating insurance is to understand the difference between in-network and out-of-network benefits. Here’s a quick guide to how in-network benefits work.
Mental health care is usually included in health insurance plans that cover your kids, but the specific benefits vary a lot depending on your insurance provider and plan. To get the most out of your family’s insurance and avoid unexpected costs, it’s important to figure out exactly what your plan covers before your child gets care.
With in-network benefits, your insurance will only pay for care provided by someone who has a contract with the insurance company.
To find out if your QBH provider is in-network with your insurance company, you can check the list on the insurance company’s website. We also suggest you ask your Quality Behavioral Health Intake Coordinator. Sometimes the insurance company’s information is out of date, or the provider might not be taking new patients with your plan right now. We recommend calling QBH ahead to confirm that the provider takes your insurance.
It’s important to remember that even with an in-network provider, your child’s insurance company will not pay for care until the deductible is met. The deductible is the amount that you must pay for all your child’s health care each year before the insurance company will cover care. So, if you haven’t met your deductible that year, you would have to pay the provider’s full fee until the deductible is met.
The upside of using in-network benefits is that it is usually much more affordable than using out-of-network benefits. If your deductible has been met, you only pay the copay for each session.
To learn more information about out-of-network benefits
Getting information from the insurance company
Because insurance plans are often complicated, the best way to find out exactly what your insurance covers is to talk with a representative from your insurance company. You can do this by calling the phone number on the back of your insurance card, you may also contact a representative through the company’s online portal.
Make sure you have your insurance card with you when you call, since you’ll need the information on it to find out more about your plan.
Questions to ask
The goal of talking to the insurance company is to find out everything you can about what your family’s insurance plan covers, how payment works, and how much of the cost of treatment you would be responsible for. It helps to write down all your questions ahead of time. Here are some of the questions you can ask:
- Does my plan include in-network mental or behavioral health care? How about out-of-network benefits?
- Do I or my child need a diagnosis for their treatment to be covered? If so, which diagnoses are covered?
- Do I or my child need a referral from their doctor before seeing a QBH mental or behavioral health care specialist?
- Does my insurance company require pre-approval to pay for care?
- What is my co-pay for my or my child’s in-network care?
- Has my deductible been met for this year? If not, how much more do I need to pay before it is met?
- Is there a limit on how many visits my child’s insurance will cover?
- What about dollar limits or any other limits on coverage?
- Does my plan cover the cost of medications for mental health concerns? Are there copays for medications?
