Q: How does insurance work?

I am a currently a preferred provider with Aetna and Optum (United Behavioral Health). I am contracted with them for both Mental Health and EAP coverage.

Sometimes the mental health portion of your insurance coverage is "carved out" to a separate Behavioral-Health specific insurance company.  This can make it a little bit confusing to determine if I am in network for you or not - For example, you may have a plan that is called "UMR" for your health insurance.  Optum Behavioral Health manages the Mental Health portion of UMR medical plans - so for UMR members, I am an in-network Behavioral Health Provider (even though you don't see me list UMR as one of my networks that I'm in) 

The best way to find out if I am in network with your insurance is to call them and ask.  There is usually a separate phone number on your insurance card for Mental Health services.  Call that number.  Or, if you'd prefer, I can make that call on your behalf.

If I am NOT in network with your insurance,  I will provide you with a "superbill", a specific type of receipt that you then submit to your insurance company for any possible out of network reimbursement.

If you make the call to determine what type of coverage you might have,  you should ask the following questions:

  • What are my mental health benefits for outpatient psychotherapy?

  • If you are seeking marital counseling, this may be covered differently. Please ask specifically about marital/family/couples coverage if that applies to you.

  • Can you verify if Angie Leek, LMFT is an in-network provider?

  • What is my co-pay or co-insurance? (If you have a copay, then it's just that, a specific dollar amount that you pay per session.  If you have  co-insurance, then you pay a percentage of the contracted or allowable rate. To find out a specific dollar amount, you can ask what is the "contracted rate" for an in-network providers or "Usual and Customary Rate/UCR" for out of network providers. 

  • How many therapy sessions does my plan cover?  Is that the same for both in out of network provider?

  • Is pre-autorization required?  Is pre-authorization required for out of network therapy?

  • Is there a deductible that must be met before my coverage begins?  Is there a deductible that must be met before out of network coverage or reimbursement begins?

I have worked at a Behavioral Health insurance company and am knowledgeable about this industry.  I can help you navigate the sometimes complicated system. Ambetter