Insurance

Find out if your health insurance plan covers out-of-network therapy sessions by following these steps

1. Call your health insurance provider. This number is usually on the back of your health insurance card. 

2. Ask whether you have out-of-network benefits specifically for mental health. If the answer is “no”, and you have health insurance through your employer, consider asking your employer if they offer other health insurance plans with out-of-network benefits for mental health — or if they plan to do so in the future. Sometimes employers are willing to expand the plans that they offer to their employees.

3. Ask whether you need pre-authorization for psychotherapy. 

4. Ask whether you have an annual out-of-network mental health deductible. If so, ask how much it is and how much of it has been met so far. Ask what the policy year is (for example: January 1 – December 31), so that you can calculate when your annual out-of-network mental health deductible restarts.

5. Ask what percentage your health insurance provider will cover per mental health session once they begin reimbursing you (i.e. once you meet your annual out-of-network mental health deductible). You can also ask what your co-insurance is.

6. Ask if they cover Clinical Procedure Terminology (CPT) codes 90834 and/or 90837 (the latter is for 60-minute sessions). These are the medical codes that we bill under for the service of ongoing individual psychotherapy.

7. Ask what the maximum $ amount per mental health session is that they consider reasonable and customary. This is the amount that your health insurance plan determines is the normal range of payment within a given geographic area. Sometimes, it's $100, which means that they reimburse a percent of $100; other times, it's much higher, which means that they will cover more. They may not answer this question, because they often don't like to give out this information.

8. Ask how many mental health sessions per year are covered. Sometimes, it's unlimited.

9. Ask how you get reimbursed / submit a claim for reimbursement. Ask how many days it takes for the claim for reimbursement to be processed and for the reimbursement to be sent to you. Typically, it takes about a month.

10. Ask what your plan's annual out-of-network out-of-pocket maximum limit is — meaning, once you hit a certain $ amount of out-of-network out-of-pocket payments (for example: $2,000), you may be eligible for 100% reimbursement of out-of-network costs.

If they ask you for therapist information, you can share the below:

Lorena Maldonado, LCSW
NY License: 103005
NPI: 1669109989
Tax ID: 42-2750855
Clinical Procedure Terminology (CPT) code: 90837

Find out if your health insurance plan covers out-of-network therapy sessions by entering your information

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.



For questions or more information about your right to a Good Faith Estimate, visit http://www.cms.gov/nosurprises or call (800) 985-3059.